Long‐Term Outcomes of the Anterior Ethmoidal Artery Flap for Nasal Septal Perforation Repair

ABSTRACT Objectives The anterior ethmoidal artery (AEA) flap has demonstrated high success for nasal septal perforations (NSP) closure. Most studies on success have been limited by small samples, short follow‐up duration, and lack of symptom reporting. This study aimed to determine long‐term technical and symptomatic success of AEA flap closure of NSPs. Methods A multicenter retrospective cohort study was conducted on all patients who underwent at least a unilateral AEA flap with or without interposition grafts and/or septal mucosal turn‐in flaps for contralateral coverage. Primary outcomes were NSP closure rate, time to reperforation, bothersome symptomatic resolution (binary present or absent), and whether patients were happy they underwent surgery. Demographics, comorbidities, preoperative symptoms, NSP etiology and size, and techniques were compared between successful closures and reperforations. Results Of 124 patients, median age was 43.5 years, and 71.1% were female. NSPs were most commonly idiopathic (35.5%) or from surgical trauma (31.5%). Median NSP dimensions were 1.0 cm × 1.0 cm. Minimum follow‐up duration was 1 year (range = 1–7.5 years). NSP closure rate was 90.3% (110/124) at 6 months postoperatively, but ultimately was 70.2% (87/124), with 67.6% of reperforations occurring after 1 year postoperatively (19/37). Overall, patients most commonly experienced resolution of bothersome symptoms, and 90.3% were happy they underwent NSP repair. Conclusion While NSP closure success was 90% at 6 months postoperatively, success dropped to about 70% at final follow‐ups, with a majority of failures occurring after 1 year postoperatively. Patients most often achieved long‐term symptomatic relief and were happy they had undergone NSP repair. Level of Evidence 4.