A Three-Layer Composite Graft Technique for Repair of Medium and Large Nasal Septal Perforations.

Background: Repairing nasal septal perforations (NSPs) is a complex procedure involving various surgical techniques, with success rates that vary significantly. As the size of the perforation increases, the surgical challenge intensifies and success rates tend to decline. This highlights the need for more effective and reliable repair methods. Objectives: The aim of this study is to evaluate the effectiveness of a three-layer sandwich technique using a polydioxanone (PDS) plate, tragal cartilage, and temporalis fascia in repairing medium- and large-sized NSPs. Methods: Between March 2022 and November 2024, 21 patients who underwent surgery for nasal septal perforation at our clinic were evaluated. Of these patients, 6 had medium-sized perforations (11-20 mm), while 15 had large perforations (> 20 mm). In all cases, the perforation was repaired using a combination of a PDS plate, tragal cartilage, and temporalis fascia grafts. The patients were followed for an average of 8 months postoperatively. Complete closure of the perforation was defined as the criterion for surgical success. Results: Complete closure of the septal perforation was achieved in 18 out of 21 patients (85.7%). Two patients experienced partial closure, yet both reported symptomatic improvement. No major postoperative complications were observed during the follow-up period. Conclusions: The surgical technique utilizing a combination of PDS plate, tragal cartilage, and temporalis fascia appears to be a reliable method for the repair of medium and large septal perforations, with a high success rate and a low risk of complications. Compared to techniques described in the existing literature, this approach offers significant advantages in terms of structural support and mucosal healing.