Septal Perforation Repair With Acellular Human Dermal Allograft

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Abstract
TO ACHIEVE a 90% or greater success rate with repairs of septal perforation in patients with perforations less than 3 cm requires not only bilateral repair of the mucoperichondrial flaps via transposition of the flaps with suture closure of the previous existing defect, but also the interposition of a connective tissue autograft between the repaired flaps.1-7 Numerous autografts have been used for this purpose; the most favored grafting material is temporalis fascia. Pericranium and mastoid periosteum have been used less often but with similar success rates.2,7 Temporalis fascia and pericranium are extremely thin grafts with very low metabolic requirements and have been shown to act as excellent templates for overlying tissue migration and vascularization. Mastoid periosteum has been used with the hope of adding bulk to the thickness of the resultant repaired septal membranes. It also has been used with the still unproved hope that bone might be regenerated between the septal flaps.2 The need for a connective tissue interpositional graft is generally accepted by all authors who use intranasal mucosal flap advancements. The interposed graft maintains a barrier between the corresponding repaired flaps during healing and, therefore, decreases the risk of incisional breakdown and reperforation.