Meyer R
Centre de Chirurgie Plastique, Lausanne, Suisse.
Ann Chir Plast Esthet. 1992 Mar;37(2):154-61.
According to my experience extending over more than 20 years (more than 100 cases) in the treatment of septal perforations, I have the deep conviction that all techniques using local flaps should actually be considered to be obsolete, as the blood supply is insufficient. Perforations with diameter up to 4 cm can be closed in a one stage procedure with extensive dissection of the muco-perichondrium and mucoperiosteum of the septum, the vault and the vestibular and cavity floor. The hole in the quadrangular plate can be reduced by a push back or push down manoeuver of part of the cartilage. For closure of perforations larger than 4 cm in diameter, I use a 2-3 stage procedure using a composite buccal flap with three layers (mucosa-cartilage and mucosa) and a gingivo-labial pedicle. Thus all kinds and sizes of perforations can be closed surgically avoiding the use of silicone obturators which only enlarge the hole.
根据我20多年来（超过100例）治疗鼻中隔穿孔的经验，我深信所有使用局部皮瓣的技术实际上都应被视为过时，因为血供不足。直径达4厘米的穿孔可通过对鼻中隔、鼻穹窿、前庭及腔底的黏膜软骨膜和黏骨膜进行广泛剥离的一期手术来闭合。通过将部分软骨向后推或向下推的操作可缩小方形软骨板上的孔。对于直径大于4厘米的穿孔，我采用两到三期手术，使用带有三层结构（黏膜 - 软骨和黏膜）的复合颊部皮瓣及龈唇蒂瓣。这样，各种类型和大小的穿孔都可通过手术闭合，避免使用只会扩大穿孔的硅胶阻塞器。
