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Experience of using the P. Castelnuovo flap in the postoperative nasal septal perforation repair

Postoperative nasal septum perforation (PNSP) is a complication of nasal septum (NS) surgery with an incidence of 1–8%. The effectiveness of surgical treatment ranges from 52 to 92%. In world practice, Castelnuovo operation is actively used, while the effectiveness of this technique in the treatment of PNSP requires a comprehensive study. Objectives: To assess the effectiveness of the method of closing the PNSP with a Castelnuovo flap. Materials and methods: 26 patients with PNSP were operated on. The number of patients depending on the area (S) of the PNSP: S <1 cm2 – 2, S 1–2 cm2 – 21, S > 2 cm2 – 3. In the postoperative period, cytological examination of smears from the NS surface was carried out (3rd, 6th, 10th, 15th, 20th days), questionnaire survey NOSE and assessment of mucociliary transport of the mucous membrane (MM) of the nasal cavity (10th, 15th, 20th, 25th and 30th, 40th 60th day), the presence of relapses of PNSP within 1 year were performed. Results: pronounced leukocyte infiltration and bacterial contamination of the wound were revealed up to 10 days, reparative processes were not expressed until 15 days. The indicators of mucociliary transport were brought back to normal by the 30th day (21,25 ± 1,90 minutes), the results of the NOSE questionnaire by the 60th day were 22.12 points, which corresponded to the zone of comfortable breathing. In all 26 patients, intraoperatively complete closure of the PNSP was performed. There were 7 recurrences of PNSP: 3 in the interval of 16–30 days, 2 – from 31 to 60 days, 1 – from 61 to 90 days, 1 – from 4 to 6 months. Synechiae between NS and inferior turbinate was found in 11,5%. The efficiency of Castelnuovo flap closure technique of PNSP was 73%. Conclusions: The results indicate a pronounced inflammation in the flap and NS tissues in the postoperative period and a change in the physiological course of the wound process in favor of healing by secondary intention.