CASE REPORT James I. Cohen, MD, PhD, Section Editor SURGICAL TECHNIQUE FOR RECONSTRUCTION OF THE NASAL SEPTUM: THE PERICRANIAL FLAP Vicente Paloma, MD, PhD, 1 Alberto Samper, MD, 2 Francisco J. Cervera-Paz, MD 3 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Clínico de Barcelona, Barcelona, Spain 2 Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital and Medical School, Clinica Universitaria de Navarra, Avda. Pio XII nr. 36, 31008, Pamplona, Spain. E-mail: asamper@unav.es 3 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and Medical School, Pamplona, Spain Accepted 11 May 1999 Abstract: Background. We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. Methods. The technique requires a standard open rhino- plasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. Results. Surgery resulted in a permanent and complete clo- sure of the perforation. Conclusions. The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations. © 2000 John Wiley & Sons, Inc. Head Neck 22: 90–94, 2000. Keywords: septum; reconstruction; cocaine; pericranial; flap; perforation The incidence of septal perforation has increased in the last decade in direct relation to cocaine abuse. When nasal perforations are small, the treat- ment should be conservative, with saline, serum, and mineral oils to decrease crust formation and the sensation of nasal obstruction. Surgical treat- ments for small to medium sized perforations in- clude local mucosal flaps, prosthetic polymers of silicone, or compound flaps. Any of these options are acceptable, but the repair of symptomatic large perforations may be more difficult to man- age. In this article we report a new surgical tech- nique suitable for cases of complete destruction of the nasal cartilaginous septum. CASE REPORT We present the case of a 55-year-old male, who had been a chronic cocaine abuser for 20 years and who had a massive perforation of nasal sep- tum (Figure 1). The perforation involved the whole cartilaginous portion of the nasal septum except for the portion at the dorsum and apex (Figure 2). The patient’s main complaint was chronic and continuous nasal crust formation. He Correspondence to: A. Samper CCC 1043-3074/00/010090-05 © 2000 John Wiley & Sons, Inc. 90 Nasal Septum Reconstruction HEAD & NECK January 2000