What is the evidence for the use of mucosal flaps in Draf III procedures?

PURPOSE OF REVIEW: Recent literature has described the use of mucosal grafts or transplants to reduce the rate of frontal ostium restenosis after the endoscopic-modified Lothrop procedure. This article presents a review of the literature on the rates of revision and restenosis related to Draf III procedures, factors implicated in the causation of restenosis and the evidence to support the role of mucosal grafts in reducing restenosis rates. RECENT FINDINGS: Compared to historic data and to the meta-analysis data by Anderson and Sindwani, results from three case series examining the use of mucosal flaps after endoscopic-modified Lothrop procedure look extremely promising compared to a baseline average stenosis rate of 19% and revision rate of 14% quoted in the literature. SUMMARY: Although the concept appears sound in principle and the limited series published show potential reduction in revision rates, there is inadequate evidence to state conclusively that this technique will improve the results of Draf III procedures in all surgical hands.