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6,7 The preliminary results for 24 patients were excellent in over 90% of the cases. Favorable outcomes have been reported also after using cartilage interposition grafts, either with periosteum and/or fascia or even without any graft.2,8�C11 However, periosteum and fascia requiring only one distant donor site has not been evaluated earlier in a large patient series.4,5 In the present study, we evaluated the outcomes and complications of nasal septal perforation surgery in our hospital, and present the results of the bilateral bipedicled mucoperichondreal bepotastine advancement flap with fascial or periosteal graft (BAF). Possible causes of perforation and predictive factors of surgical outcome were also assessed. Materials and Methods This retrospective study was conducted at the Department of Otorhinolaryngology��Head and Neck Surgery, Helsinki University Hospital (HUH), Helsinki, Finland. The study complied with the principles of the Declaration of Helsinki. According to the law of Finland a Research Ethics Board approval will not be needed for retrospective hospital chart find more reviews. An institutional research approval was granted for the study. HUH is a tertiary care academic center for a population of 1.87 million and the only hospital in this referral area performing surgical management of nasal septal perforations. All patients with a nasal septal perforation operated on between April 2007 and August 2014 were included. Four out of the five operating surgeons were doctors in training for rhinosurgery, and they performed their first operations on septal perforations at the beginning of this study period. We collected data on comorbidities, smoking, medication, evident cause of perforation, perforation Olaparib size, operative technique, tissue graft, closure rate, outcome, and complications. All the patients had been instructed to apply moisturizing sprays and ointments regularly prior to making the decision for operative treatment. Administration of topical basitracine ointment or oral cephalosporine was used if necessary. The patients were counseled to refrain from nasal manipulation to decrease crusting and to allow healing of the perforation edges. Surgery was considered if their symptoms were not adequately controlled. Operative technique The patients were operated on while under general anesthesia. Intravenous antibiotics, typically cefuroxime, were administered during induction of anesthesia. In selected cases with large perforations or in reoperations, the lower turbinate flaps were raised and the temporal fascia was harvested.12 For smaller perforations, various techniques were used with auricular cartilage graft when needed. Repair with a fat graft similar to the tympanic membrane repair was used in rare cases.13 The endonasal approach was used in all but one BAF patient who needed an open rhinoplasty.