Temporoparietal fascia and PDS plate: letting the mucosa grow back

The resorbable plate wrapped in fascia is slid between the two mucosal layers, unsutured.

First described by : Flavill and Gilmore, Laryngoscope 2014: “septal perforation repair without intraoperative mucosal closure”. Developed since by Stephan (Vanderbilt), the Zurich team, Cleveland Clinic and a multi-institutional American group.

Every other technique tries to cover the hole with mucosa on the day of surgery. This one takes the opposite bet: a resorbable polydioxanone plate, wrapped in fascia harvested from the temple, is interposed through the perforation, and the mucosal flaps are left unsutured. The mucosa grows back over that scaffold, under splints, for six to twelve weeks. No nasal tissue is moved or consumed, which keeps every option open if it fails.

1. 1Harvest of a strip of temporoparietal fascia through an incision hidden in the hair, above the ear.
2. 2A resorbable PDS plate is cut to the shape of the defect, slightly larger than the perforation.
3. 3Sandwich assembly: the plate is wrapped in the fascia, which offers a surface favourable to epithelial regrowth.
4. 4Introduction through a hemitransfixion incision (closed route, no visible scar) and interposition through the perforation, between the two mucosal layers.
5. 5No mucosal suture: silicone splints for 6 to 12 weeks, rinses several times a day, endoscopic checks until coverage is complete.

Named variants

• Medium perforations, and large ones in the most recent series, with no clear link between size and success.
• Patients whose turbinates are already reduced or whose septal mucosa is exhausted: nothing is taken from the nose.
• Previous failure of a flap technique, since local options remain intact.
• Controlled inflammatory disease (granulomatosis with polyangiitis), where local tissue heals badly.
• Patients who want to avoid any visible scar: the closed route leaves nothing to see.

• Patients who will not tolerate 6 to 12 weeks of splints, with crusting and a blocked nose.
• Impossible follow-up: the technique requires regular endoscopic checks during regrowth.
• Current smoking, which compromises epithelial regrowth as much as flap healing.
• Anyone expecting an immediate result: the hole is not closed on the day, it closes over weeks.
• Marked androgenic alopecia, where the temporal incision shows more.

Published results

• A failure mode of its own: no initial closure (the mucosa does not cover) rather than late re-perforation.
• A long splinting phase, with crusting, blockage and reduced smell.
• Temporal site: scar hidden in the hair, small risk of alopecia or injury to the frontal branch of the facial nerve.
• Intolerance or extrusion of the plate before it resorbs.
• Retrospective series, modest numbers, little follow-up beyond a few months.

1. 1Exactly how long will I keep the splints, and who removes them?
2. 2What do you do if the mucosa has not fully grown back at 12 weeks?
3. 3Where will the temporal incision be, and what is the risk to the forehead nerve?
4. 4How many repairs of this type have you done, and with what rate at 6 months?
5. 5Does this technique leave my other options intact if it fails?

Write the answers down: they are what lets you compare two opinions.

Where it is done

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