An Innovative Technique for Septal Perforation Repair: Costal Cartilage and Abdominal Rectus Muscle Fascia Sandwich Graft

Objective: Nasal septal perforation repair remains challenging, particularly for medium and large defects, for which reliable closure techniques are limited. This study aimed to evaluate outcomes of a novel reconstruction using a costal cartilage-rectus abdominis fascia sandwich graft in symptomatic septal perforations. Methods: In this retrospective study, 15 symptomatic patients with medium (0.5–2.0 cm) or large (2.0–2.5 cm) perforations underwent repair between July 2022 and July 2023. Costal cartilage and rectus abdominis fascia were harvested to create a sandwich graft interposed between bilaterally elevated mucoperichondrial flaps via open septoplasty, exceeding perforation margins by ∼1 cm. Demographics, perforation size, smoking status, and outcomes were analyzed. Results: Fifteen patients (6 females and 9 males; mean age: 36.4±7.8 y) were included. Closure was achieved in 12 patients (80%); 3 failures occurred (2 large and 1 medium). No significant association was found between outcome and age ( P =0.42), sex ( P =0.61), smoking ( P =0.55), or perforation size ( P =0.27). No intra- or postoperative complications were observed. Conclusion: Utilizing costal cartilage combined with rectus abdominis fascia as a sandwich graft is a promising and effective technique, particularly for large septal perforations.