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

Abstract

Objectives/Hypotheses: The nasoseptal flap has become the workhorse for reconstruction of large skull base defects in endoscopic endonasal skull base surgery. The nasoseptal flap, though useful in reconstruction, may lead to significant donor site morbidity. Specifically, exposed cartilage and bone of the nasal septum leads to prolonged crusting, as well as potential cartilage necrosis and septal perforation. Published techniques to reduce the donor site morbidity include free mucosal grafting and septal rotational flaps, and these techniques have shown reduced crusting and healing/re-mucosalization times. Free mucosal grafts described in these techniques are harvested from a resected middle turbinate. However, middle turbinectomy is not always necessary for surgical access and is associated with its own potential side effects, such as altered nasal air flow, reduced nasal humidification and the potential for empty nose syndrome. We present a novel technique which involves harvesting posterior septal mucosa from the side contralateral to the nasoseptal flap as a free mucosal graft for reconstruction of the anterior septal donor site. The septal mucosal graft is taken from the overlying mucosa at the posterior septectomy site of the endonasal approach to skull base tumors; this mucosa would typically be discarded after removal.