Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique Using a Posterior Septal Free Mucosal Graft

Abstract

Objectives The nasoseptal flap (NSF) has become the workhorse for reconstruction in endoscopic endonasal skull-base surgery. The NSF, though useful in reconstruction, may lead to significant donor site morbidity. Published techniques to reduce the donor site morbidity, free mucosal grafts, and septal rotational flaps have shown to reduce crusting and remucosalization times. We present a novel technique utilizing posterior septal mucosa as a free mucosal graft for reconstruction of the anterior septal donor site. The septal mucosal graft is taken from the mucosa overlying the posterior septectomy site of the endonasal approach to skull base tumors. Design Retrospective chart review. Setting Single tertiary academic medical center. Participants All patients who underwent endoscopic endonasal skull-base surgery between November 1, 2014 and August 30, 2015 with free mucosal graft reconstruction of the NSF donor site. Main Outcome Measures Postoperative graft success. Results Fifteen patients underwent septal reconstruction using a septal free mucosal graft. There was a 100% graft success rate with near complete remucosalization by 6 weeks postoperatively. Conclusions The posterior septal free mucosal graft is a simple, reliable method for reconstructing the NSF donor site. The advantages of this technique include utilization of native septal mucosal tissue and middle turbinate preservation.

Keywords: nasal cavity/surgery; nasal mucosa/transplantation; nasal septum/surgery; skull base/pathology; skull base/surgery.

Fig. 1

Still image of the left-sided posterior septal free mucosal graft in the process of harvest. IT, inferior turbinate; MG, mucosal graft; MT, middle turbinate; S, septum.

Fig. 2

Still image of the posterior septal free mucosal graft after removal from the nose, in process of being marked on the mucosal side.

Fig. 3

Still image of placement of the mucosal graft onto anterior septal nasoseptal flap donor site. Secured to septum with a 4–0 plain gut suture in quilting fashion. IT, inferior turbinate; MG, mucosal graft; SC, septal cartilage.

Fig. 4

Postoperative week 6 image of a septal mucosal graft. A small crust noted anteriorly along the edge of the graft. C, crust; MG, mucosal graft; MT, middle turbinate.