Dynamic septal reconstruction using the Tsubasa flap: integration of depressor septi nasi muscle and temporoparietal fascia
European Journal of Plastic Surgery, vol.49, no.1, 2026 (ESCI, Scopus)
- Publication Type: Article / Article
- Volume: 49 Issue: 1
- Publication Date: 2026
- Doi Number: 10.1007/s00238-026-02459-x
- Journal Name: European Journal of Plastic Surgery
- Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, EMBASE
- Keywords: Composite flap, Depressor septi nasi muscle, Nasal reconstruction, Rhinoplasty, Septal perforation, Temporoparietal fascia
- Lokman Hekim University Affiliated: Yes
Abstract
Background: Nasal septal perforations represent a challenging reconstructive problem with no universally accepted repair technique. Success rates vary significantly based on perforation size, aetiology, and surgical approach, particularly for medium-to-large defects (1–3 cm), where conventional flaps often fail due to tension or inadequate vascularization. Methods: This retrospective cohort study evaluated 15 consecutive patients (9 males, 6 females; mean age 38.4 ± 11.2 years) undergoing septal perforation repair using a novel composite flap integrating the depressor septi nasi (DSN) muscle with a temporoparietal fascia (TPF) graft (Tsubasa flap). Perforation sizes ranged from 1.1 to 3.1 cm (mean 1.8 ± 0.6 cm). Primary outcome was endoscopic perforation closure at 6 months; secondary outcomes included symptom resolution and complication rate. Written informed consent was obtained from all participants. Results: Complete perforation closure was achieved in all 15 patients (100% success rate; 95% CI: 78.2–100%) at final follow-up (mean 22.3 ± 8.1 months; range 6–31 months). Symptom resolution was observed in 100% for nasal obstruction and whistling, and 93% for crusting/epistaxis. No major complications occurred; minor transient tip hypoesthesia resolved spontaneously in two patients by 3 months. No recurrences were documented during the follow-up period. Conclusions: The DSN-TPF composite flap provides a well-vascularized, tension-free reconstructive option for medium-sized septal perforations with excellent short-to-mid-term outcomes. Its dual-plane design addresses both structural support and mucosal coverage limitations of conventional techniques. Multi-center validation with comparative cohorts is warranted before widespread adoption. Level of Evidence: Level IV, therapeutic study.