Reconstruction of large nasal septal perforations with a three layer galeal pericranial flap: an anatomical and technical study.

OBJECTIVES In this study, a modified surgical method was carried out to repair large nasal septal perforations with a galeal pericranial flap using endoscopic technique. MATERIALS AND METHODS Six adult human cadavers were dissected by applying the classic open rhinoplasty technique. Large perforations were created in the septal cartilages. To repair the perforations, we prepared galeal pericranial flaps with supraorbital neurovascular pedicles and calvarial bone grafts under endoscopic visualization. The flaps were inserted between the upper lateral cartilages and folded into three layers. The flaps were sutured to the nasal mucosa with absorbable sutures. The length, the width, the size of the flaps and the perforations were measured using an electronic caliper and a flexible ruler. RESULTS The mean length and width of the flap pedicles were measured as 26.8±5.1 mm (range 20 to 32 mm) and 19.3±2.6 mm (range 15 to 23 mm), respectively. In addition, the mean length and the width of the flaps were 54.1±4.9 mm (range 50 to 60 mm) and 51.6±7.8 mm (range 45 to 63 mm), respectively. All of the nasal septal perforations were repaired with a galeal pericranial flap. CONCLUSION The galeal-pericranial flap is well-vascularized and similar to the nasal mucosa for tissue thickness. Therefore, reconstruction with galeal-pericranial flaps can be an alternative surgical technique for repair of large nasal septal perforations.