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To the Editor.—Drs. Fairbanks and Chen, in their article "Closure of Large Nasal Septum Perforations," are to be congratulated for making a significant contribution to the literature, in that for the first time a technique is described that is sufficiently dependable to be recommended to patients afflicted with this condition.
Their basic technique uses some of the many previously described "Flap Advancement Operations"; and to this they have added a desiccated connective tissue graft, after the concept of James Sheehy's tympanic grafts.
I would agree with them that this connective tissue graft is the reason for their improved success rate, but would like to add some discussion and hypotheses that might help to explain some of the still unanswered questions and direct investigation in such a way as to provide answers for the others.
Flap techniques to close perforated nasal septums have generally achieved a success rate of