Introduction
Nasal obstruction is a frequently reported symptom in otolaryngology that can significantly diminish a patient’s quality of life by affecting breathing, sleep and daily activities.Reference Stewart, Smith, Weaver, Witsell, Yueh and Hannley1 One of the most common anatomical causes of persistent nasal obstruction is a deviated nasal septum.Reference Dinis and Haider2 When medical treatments prove ineffective, septoplasty is typically performed to surgically correct the nasal septal deviation and improve airflow through the nasal passages.Reference van Egmond MMHT, Rovers, Tillema and van Neerbeek N3
Although septoplasty is a routine and generally successful operation, it carries a risk of post-operative complications. These may include mucosal injury, crust formation, adhesions (synechiae), infections and septal perforation, all of which can delay healing and adversely affect outcomes.Reference Ketcham and Han4, Reference Bloom, Kaplan, Bleier and Goldstein5 Therefore, enhancing the healing process of the nasal mucosa is a critical aspect of post-operative care.
In recent years, platelet-rich fibrin (PRF) has emerged as a promising biological agent that supports tissue repair and regeneration. PRF is a second-generation autologous platelet concentrate prepared without anticoagulants, forming a fibrin matrix enriched with platelets, leucocytes and a reservoir of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF).Reference Dohan Ehrenfest, Rasmusson and Albrektsson6, Reference Choukroun, Adda, Schoeffler and Vervelle7 These biomolecules are released slowly over several days, which helps modulate inflammation, stimulate angiogenesis and promote tissue regeneration.
PRF has found diverse applications in otorhinolaryngology, with studies reporting its successful use in procedures such as pharyngeal reconstruction, rhinoplasty, endoscopic sinus surgery and myringoplasty.Reference Dinaki, Grigoriadis, Papadopoulos, Vizirianakis, Constantinidis and Triaridis8 However, evidence regarding PRF applications specifically in septoplasty remains limited.Reference Sunnergren, Alexandersson, Broström, Eliasson, Jangard and Lilja9 Therefore, this study aimed to investigate whether intra-operative application of platelet-rich fibrin glue (PRFG) can enhance mucosal healing and reduce post-operative complications after septoplasty.
Materials and methods
Study design and setting
This prospective, single-centre, parallel-group randomised controlled trial (RCT) was conducted between January and December 2025 at the Department of Otolaryngology–Head and Neck Surgery at a tertiary referral centre. The study protocol was registered at ClinicalTrials.gov (NCT06996106) prior to patient enrolment. Institutional Review Board approval was obtained (approval no. KFSIRB200-542), and all participants provided written informed consent in accordance with the Declaration of Helsinki.
Participants
Adult patients aged 18–65 years who underwent septoplasty for symptomatic nasal obstruction secondary to septal deviation refractory to medical management were eligible for inclusion. Exclusion criteria were: coagulopathy, systemic conditions affecting wound healing (e.g., uncontrolled diabetes mellitus), active nasal infection, anticoagulant or antiplatelet therapy, prior nasal surgery, chronic rhinosinusitis or nasal polyposis (per EPOS 2020 criteria), current smoking or smoking cessation within three months prior to surgery (owing to its known adverse effects on mucosal healing) and any known haematological disorder affecting platelet function or count.
Randomisation and blinding
Participants were randomised in a 1:1 ratio to the PRFG or control group using computer-generated block randomisation (block size of four). Allocation concealment was ensured using sealed opaque envelopes prepared by a research assistant not involved in patient recruitment or outcome assessment. Patients and post-operative outcome assessors were blinded to group allocation. The operating surgeon was not blinded due to the nature of the intervention. The participant flow is demonstrated in Figure 1.
CONSORT flow diagram of participant enrolment, randomisation, follow-up and analysis.
Figure 1 Long description
The flowchart details the process of participant assessment, randomization, follow-up and analysis. Initially, 150 participants were assessed for eligibility. Out of these, 50 were excluded, with 35 not meeting criteria and 15 declining. The remaining 100 participants were randomized into two groups: PRFG and Control, each with 50 participants. In the PRFG group, 1 participant moved and 1 withdrew, resulting in 48 analyzed participants, with an intention-to-treat (ITT) count of 50. In the Control group, 1 participant lost contact and 2 withdrew, resulting in 47 analyzed participants, with an ITT count of 50. Both groups underwent analysis twice, maintaining their respective ITT counts.
Sample size calculation
The sample size calculation was based on the primary outcome of time to complete nasal mucosal epithelialisation. Using an effect size (Cohen’s d) of 0.91 reported by Dizdar et al.Reference Dizdar, Doğan, Ece, Kaya, Seyhun and Turgut10 for platelet-derived products applied during septoplasty, a minimum of 44 patients per group was required to achieve 80 per cent power at a two-sided α level of 0.05. To account for potential attrition, 50 patients were enrolled in each group, resulting in a total sample size of 100.
Preparation of PRFG
PRFG was prepared according to a modified protocol described by Nourizadeh et al.,Reference Nourizadeh, Sedaghat Sharifi, Bakhshaee, Sadat Ghiasi, Rasoulian and Hamidi Alamdari11 optimised to produce a mechanically stable fibrin matrix suitable for use as a tissue sealant. Two days before surgery, 60 ml of peripheral venous blood was collected in 9-ml tubes containing acid–citrate–dextrose.
Blood samples underwent a two-step centrifugation process: initial centrifugation at 2,000 × g for 2 minutes, followed by a second centrifugation at 4,000 × g for 8 minutes. Platelet-poor plasma (PPP) was separated, leaving approximately 4 mL of platelet-rich plasma (PRP), stored at 22 °C.
Fibrinogen was isolated from PPP using cryoprecipitation. The PPP was frozen at −80 °C and subsequently thawed at 4 °C, followed by centrifugation at 6,500 × g for 5 min to separate the fibrinogen-rich precipitate. Calcium gluconate was added to initiate clot formation, and the mixture was incubated at 37 °C to produce a fibrin clot. Immediately before surgery, the fibrin clot was combined with the prepared PRP to create PRFG, which was applied intra-operatively. The preparation of PRFG is illustrated in Figure 2.
Schematic illustration of autologous platelet-rich fibrin glue (PRFG) preparation protocol and intra-operative application technique.
Figure 2 Long description
The flowchart details the preparation of platelet-rich fibrin glue (PRFG) through several stages. The process begins with blood collection, where 60 mL of venous blood is drawn into 9 mL ACD tubes. The first stage, labeled I, is Blood Collection. Next, in stage II, Platelet-Rich Plasma (PRP) Isolation occurs. Supernatant centrifugation is performed twice: first at 4000 times g for 8 minutes and second at 4000 times g for 5 minutes, resulting in platelet-poor plasma. Stage III involves PPP Processing, where the plasma is frozen at minus 80 degrees Celsius, thawed at 4 degrees Celsius and centrifuged at 6500 times g for 5 minutes. Stage IV, PRFG Synthesis, combines 1 mL of fibrinogen with 2 mL of PRP, adding calcium and cryoprecipitate to initiate clot formation. The final stage, V, is PRFG Clot Formation, where the PRFG is formed and applied to the surgical site.
Surgical procedure
All procedures were performed by a single senior otolaryngology consultant with greater than 10 years of experience using a standardised endoscopic endonasal septoplasty technique under general anaesthesia. Partial inferior turbinectomy was not performed in any case. A single prophylactic dose of intravenous amoxicillin–clavulanate was administered during anaesthesia induction.
After topical decongestion with oxymetazoline and local infiltration of lidocaine with epinephrine (1:100,000), a unilateral Killian incision was made, and bilateral mucoperichondrial flaps were elevated on the right side. Deviated cartilaginous and bony components, including posterior septal spurs and a deviated maxillary crest, when present, were corrected using standard techniques.
In the PRFG group, PRFG was applied in the submucoperichondrial plane between the septal flaps at the end of the procedure. In cases with intra-operative mucosal tears associated with severe septal spur deviation, PRFG was applied directly to the mucosal injury area before flap repositioning (Fig. 3). In the control group, the surgical technique was identical, but no PRFG was applied.
(A) Endoscopic view of the mucosal tear in the right septal mucoperichondrial flap. R = right flap; L = left flap. (B) Endoscopic view after platelet-rich fibrin glue (PRFG) application over the mucosal tear and between the septal flaps.
The septal flaps were repositioned and secured with absorbable sutures (4-0 Vicryl). Internal nasal splints were placed bilaterally in all patients. Nasal packing was not routinely performed.
Post-operative management was standardised in both groups. All patients were instructed to perform saline nasal irrigation and receive oral analgesics as needed. Systemic antibiotics were not routinely prescribed post-operatively unless clinically indicated.
Outcome measures
All outcomes were assessed at 1, 2, 4 and 12 weeks post-operatively by blinded outcome assessors. Endoscopic examination was performed at each visit to evaluate mucosal healing and to detect post-operative complications. High-resolution endoscopic images were captured at each visit for objective scoring.
The primary outcome was endoscopic healing scores over time, described as complete endoscopic epithelialisation, defined as continuous pink mucosal coverage with normal vascularity and the absence of oedema, crusting, discharge, synechiae or exposed cartilage. Nasal mucosal healing was assessed endoscopically using the modified Lund–Kennedy endoscopic score applied to the septal mucosa at each follow-up visit. This modification was originally described and validated by Psaltis et al. who demonstrated improved inter-rater reliability by standardising photographic reference criteria and correlation with patient-reported outcomes compared with the standard Lund–Kennedy scoring system.Reference Psaltis, Li, Vaezeafshar, Cho and Hwang12 For this study, we further adapted the score for septal mucosal assessment by: (i) omitting the polyp component (as patients with polyposis were excluded) and (ii) assessing four parameters specific to septal healing: oedema (0 = none, 1 = mild and 2 = severe), crusting (0 = none, 1 = mild and 2 = severe), discharge (0 = none, 1 = thin and 2 = thick/purulent) and synechiae/scarring (0 = none, 1 = minimal and 2 = extensive). Total scores ranged from 0 to 8, with lower scores indicating better healing.
Assessments were performed independently by two blinded otolaryngologists. As evaluations were performed at predefined intervals, the time to epithelialisation was recorded as the earliest post-operative visit at which complete epithelialisation was observed.
Secondary outcomes included post-operative pain assessed using a 10-point visual analogue scale; nasal crusting; nasal obstruction assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, Stewart et al.,Reference Stewart, Smith, Weaver, Witsell, Yueh and Hannley1 a validated disease-specific instrument for assessing the impact of nasal obstruction on quality of life; a five-item questionnaire measuring nasal congestion, blockage, breathing difficulty, sleep disturbance and exercise limitation. Each item is scored 0–4, where higher scores indicate more severe obstruction and post-operative complications, such as septal perforation or synechiae formation.
Five patients were lost to follow-up (two in the PRFG group and three in the control group). These patients were included in the intention-to-treat analysis, and missing data were managed using the last observation carried forward method.
Statistical analysis
Statistical analyses were performed using SPSS software (version 27.0; IBM Corp.). Data normality was assessed using the Kolmogorov–Smirnov test. Continuous variables were expressed as mean ± standard deviation or median with interquartile range and compared using the independent-samples t-test or Mann–Whitney U-test, as appropriate. Categorical variables were expressed as frequencies and percentages and compared using the chi-squared or Fisher exact test. Intention-to-treat and per-protocol analyses were conducted. All tests were two-tailed, and p less than 0.05 was considered statistically significant.
Results
A total of 100 patients were enrolled and randomised into the PRFG (n = 50) and control (n = 50) groups. Five patients were lost to follow-up (two in the PRFG group and three in the control group). All randomised patients were included in the intention-to-treat analyses.
Baseline demographic and clinical characteristics were comparable between the groups. There were no statistically significant differences in mean age (33.84 ± 13.11 years in the PRFG group vs. 30.14 ± 10.82 years in the control group; p = 0.127) or sex distribution (p = 0.261) (Table 1).
Baseline characteristics of the PRFG and control groups
Table 1 Long description
Baseline characteristics are listed for the PRFG group and the control group, each with 50 participants, reporting gender counts and percentages and age in years as mean plus or minus standard deviation, alongside chi square or t values and P values. In the PRFG group, females were 21 participants, 42 percent, and males were 29 participants, 58 percent. In the control group, females were 28 participants, 56 percent, and males were 22 participants, 44 percent. For gender, the chi square value is 1.961 and the P value is 0.261. Mean age was 33.84 years with a standard deviation of 13.11 in the PRFG group and 30.14 years with a standard deviation of 10.82 in the control group. For age, the t value is 1.539 and the P value is 0.127.
**“Baseline characteristics of the study groups are presented in Table I. Statistical significance was set at p < 0.05, with **p ≤ 0.001 considered statistically highly significant.”
Abbreviations: χ2 = chi-squared test; PRFG, platelet-rich fibrin glue; SD, standard deviation; t = independent samples t-test.
The modified Lund–Kennedy endoscopic score was significantly lower in the PRFG group than in the control group at one week (2.72 vs. 3.46; p = 0.028) and two weeks (1.49 vs. 2.17; p = 0.006), indicating better early mucosal healing. However, no statistically significant differences were observed at one month (p = 0.39) or three months (p = 0.34) (Table 2).
Comparison of modified Lund–Kennedy score in PRFG and control groups
Table 2 Long description
Modified Lund to Kennedy score mean and standard deviation are listed for PRFG and control groups at 1, 2, 4, and 12 weeks, with a P column. At 1 week, PRFG is 2.72 and control is 3.46, P 0.028 with double asterisks. At 2 weeks, PRFG is 1.49 and control is 2.17, P 0.006 with double asterisks. At 4 weeks, PRFG is 0.28 and control is 0.38, P 0.39. At 12 weeks, PRFG is 0.00 and control is 0.02, P 0.34.
Note: Mann–Whitney U test.
** p < 0.05 statistically significant.
Abbreviations: PRFG = platelet-rich fibrin glue; SD = standard deviation
Post-operative pain scores decreased progressively in both groups. Pain scores were significantly lower in the PRFG group at one week (4.46 ± 0.87 vs. 5.21 ± 0.88; p < 0.001) and two weeks (2.10 ± 0.90 vs. 2.74 ± 0.79; p < 0.001) post-operatively. No statistically significant differences were observed at four (p = 0.114) or 12 weeks (p = 0.168) (Table 3).
Post-operative pain scores (VAS) by group and time point
Table 3 Long description
Postoperative pain scores on a visual analogue scale are listed by time point for the PRFG group and the control group, with mean and standard deviation, plus Z and P values. At 1 week, PRFG mean 4.46 with SD 0.87 and control mean 5.21 with SD 0.88, Z minus 4.42 and P reported as less than 0.001 with double asterisks. At 2 weeks, PRFG mean 2.10 with SD 0.90 and control mean 2.74 with SD 0.79, Z minus 3.75 and P reported as less than 0.001 with double asterisks. At 4 weeks, PRFG mean 0.29 with SD 0.59 and control mean 0.55 with SD 0.65, Z minus 1.58 and P 0.114. At 12 weeks, PRFG mean 0.06 with SD 0.24 and control mean 0.17 with SD 0.38, Z minus 1.38 and P 0.168.
** p ≤ 0.001 is statistically highly significant.
Abbreviations: PRFG = platelet-rich fibrin glue; SD = standard deviation; VAS = visual analogue scale; Z = Mann–Whitney test.
The prevalence of post-operative nasal crusting was significantly lower in the PRFG group during the early follow-up period. At one week, crusting was observed in 81.2 per cent of patients in the PRFG group compared with 95.7 per cent in the control group (p = 0.027). At two weeks, crusting was less frequent in the PRFG group (14.5 per cent vs. 36.2 per cent; p = 0.015). No significant differences were observed at four or 12 weeks (Table 4).
Incidence of nasal crusting by group and time point
Table 4 Long description
Nasal crusting is reported at 1 week, 2 weeks, 4 weeks, and 12 weeks, with counts and percentages for crusting no and crusting yes in the PRFG group and the control group, plus a P value for each time point. At 2 weeks, PRFG had 41 no at 85.4% and 7 yes at 14.5%, while control had 30 no at 63.8% and 17 yes at 36.2%, with P 0.015. At 4 weeks, PRFG had 45 no at 93.8% and 3 yes at 6.2%, while control had 43 no at 91.5% and 4 yes at 8.5%, with P 0.417. At 12 weeks, PRFG had 48 no at 100% and 0 yes at 0%, while control had 46 no at 97.9% and 1 yes at 2.1%, with P 0.495.
Note: Fisher’s exact test where indicated.
Abbreviations: χ2 = chi-squared test; PRFG = platelet-rich fibrin glue.
Nasal obstruction, assessed using the NOSE scale, improved significantly in both groups post-operatively. Improvement was greater in the PRFG group at one and two weeks (p < 0.001 for both comparisons). At four and 12 weeks, NOSE scores were comparable between the groups (Table 5).
NOSE scores by group and time point
Table 5 Long description
NOSE scores are reported by time point for the PRFG group and the control group, each as a median with range, alongside Z and P values. At 1 week, PRFG is 3 with range 2 to 5 and control is 4 with range 3 to 5, with Z minus 4.534 and P reported as less than 0.001 with double asterisks. At 2 weeks, PRFG is 2 with range 1 to 3 and control is 3 with range 1 to 4, with Z minus 3.837 and P reported as less than 0.001 with double asterisks. At 4 weeks, both groups have a median of 1 with range 0 to 2, with Z minus 0.503 and P 0.615. At 12 weeks, both groups have a median of 0 with range 0 to 1, with Z minus 0.026 and P 0.979.
** p ≤ 0.001 is statistically highly significant.
Abbreviations: NOSE = Nasal Obstruction Symptom Evaluation; PRFG = platelet-rich fibrin glue; Z = Mann–Whitney test;
Post-operative complications were infrequent in both groups. No post-operative septal perforations were noted. No cases of post-operative infection, significant bleeding, synechiae or adverse reactions attributable to PRFG application were observed. Complication rates did not differ significantly between the groups.
Discussion
Effective post-operative mucosal healing is as critical for the success of septoplasty as the surgical correction of septal deviation. Nasal physiology and patient satisfaction may be compromised by delayed epithelialisation, which puts patients at risk for problems such as crusting, synechiae, infection and septal perforation.Reference Selvarajah, Saim, Bt Hj Idrus and Lokanathan13–16 Platelet-derived mediators play a crucial regulatory role in the intricate biological processes of wound healing, including haemostasis, inflammation, proliferation and remodelling.
Angiogenesis, fibroblast proliferation and epithelial regeneration are enhanced by PRFG, providing a physiologically active fibrin scaffold that promotes the continuous release of growth factors and cytokines.Reference Singh, Singh, Singh and Singh17
To our knowledge, this study is one of the first RCTs to evaluate the effect of intra-operative PRFG on nasal mucosal healing following septoplasty. Although PRP and PRF have been investigated in rhinoplasty, endoscopic sinus surgery and turbinate procedures, evidence regarding their application in septoplasty remains limited.Reference Dizdar, Doğan, Ece, Kaya, Seyhun and Turgut10, Reference Yigit, Kirgezen, Özdemir, Ture, Cagliyan and Yigit18–Reference Topdag, Ozturk, Mutlu, Ulu, Calim and Is20 Importantly, the existing literature consistently demonstrates a pattern of early benefit without sustained long-term effect—a finding that is confirmed by the results of the present study.
Intra-operative PRFG treatment considerably accelerated mucosal epithelialisation in this study compared to the control group, demonstrating its potential for regeneration; however, this advantage was not maintained at four or 12 weeks. These results are consistent with those of Yigit et al., who found that the use of PRF in rhinoplasty promoted early mucosal healing and decreased facial oedema.Reference Yigit, Kirgezen, Özdemir, Ture, Cagliyan and Yigit18 Similarly, Başkadem Yilmazer et al. reported improved wound closure and reduced fistula formation after pharyngeal reconstruction using PRF, whereas Salaheldin et al. 16 showed improved mucociliary clearance and epithelial repair after submucosal diathermy of hypertrophied inferior turbinate with PRP application.Reference Başkadem Yilmazer, Aksungur, Çelik, Bayram, Turgut and Dinç21 These positive results may be explained by the extended biological activity of PRF, which contrasts with the transient release profile of PRP due to its thick fibrin architecture and slow release of growth factors such as PDGF, TGF-β and VEGF.Reference Dinaki, Grigoriadis, Papadopoulos, Vizirianakis, Constantinidis and Triaridis8
Post-operative pain was significantly reduced in the PRFG group during the first two post-operative weeks, although this difference was not sustained at subsequent follow-ups. This temporal analgesic effect is consistent with previous reports by Tutar et al. and Sadek et al., who attributed early pain reduction to PRF’s anti-inflammatory properties and its protective effect on exposed nerve endings during the acute inflammatory phase of wound healing.Reference Tutar, Ekincioglu, Karaketir, Berkiten, Saltürk and Arkan22, Reference Sadek, Hammad, Hassan, Zaki and Zayed23
At one and two weeks post-operatively, nasal crusting—a marker of mucosal moisture and epithelial maturity—was significantly less prevalent in the PRFG group. These results align with those of Sari et al. after endoscopic sinus surgery and Dizdar et al. after PRP septoplasty, indicating that maintaining a moist healing environment with platelet-derived biomaterials may serve as transient biological dressing that prevents desiccation of the regenerating mucosa.Reference Dizdar, Doğan, Ece, Kaya, Seyhun and Turgut10, Reference Sari, Karaketir, Kumral, Akgun, Gurpinar and Hanci19
Reduced oedema and crust development most likely contributed to the early improvement in nasal obstruction in the PRFG group, as evidenced by decreased NOSE scores within the first two weeks. Crucially, no significant intergroup differences were observed at four or 12 weeks across any outcome measure. These findings indicate that PRFG accelerates the early recovery period rather than altering long-term anatomical results, confirming the established pattern seen with platelet-derived products in nasal surgery.Reference Dizdar, Doğan, Ece, Kaya, Seyhun and Turgut10
Post-operative complications were rare in both groups. Although severe septal spur deviations frequently resulted in intra-operative mucosal lacerations, the PRFG group did not experience any post-operative septal perforations. These results imply that PRFG, especially in complex septal anatomy, may improve mucoperichondrial integrity and provide deficient flap mechanical support. Other studies have reported similar results.Reference Dizdar, Doğan, Ece, Kaya, Seyhun and Turgut10, Reference Topdag, Ozturk, Mutlu, Ulu, Calim and Is20 No patient experienced severe bleeding, post-operative infections, synechiae or negative PRFG application-related responses.
The findings of this study suggest that PRFG is most appropriately indicated for selected septoplasty cases rather than routine application. Specifically, patients with severe septal spur deviation, intra-operative mucosal tears or compromised mucoperichondrial flaps may derive the greatest benefit from PRFG as a biological adjunct to support flap adherence and reduce early complications. Future studies may explore its potential utility in a broader range of cases, including those with intact mucosa but suspected increased risk of septal perforation owing to thin mucoperichondrial flaps; however, such indications remain speculative and are not supported by the current data. The logistical demands of PRFG preparation should be considered in any future clinical application.
Our intervention is unique in that PRFG is formulated as a viscoelastic, adhesive hydrogel, rather than a traditional PRF membrane. Although conventional PRF membranes have shown promise in osseous or gingival applications, they are not ideal for use in highly mobile mucosal areas, such as the nasal septum, owing to their low adherence and limited tensile strength. In contrast, our method, which combined cryoprecipitated fibrinogen with PRP, produced a structurally cohesive biomaterial that could maintain inter-positional integrity between mucoperichondrial flaps and conform to irregular septal topography, even in the presence of intra-operative mucosal tears.
The clinical applicability of PRFG warrants careful consideration. The preparation protocol requires venepuncture and blood processing two days before surgery, adding logistical complexity to the pre-operative pathway. The centrifugation steps and cryoprecipitation procedure require trained personnel, specialised equipment and additional theatre time for preparation. Whilst the constituent materials (autologous blood, calcium gluconate) are inexpensive, the overall workflow burden is non-trivial. Formal health economic evaluation would be required before any cost-effectiveness claim could be substantiated.
The strength of this study is that it is an RCT and could potentially answer some questions regarding the addition of solutions and the focus on a specific technique for better healing. This technique could potentially be used for other procedures, such as functional endoscopic sinus surgery (FESS) and drill-outs, and in patients with weak mucosa or flaps. PRFG application appears to be most beneficial for optimising early recovery after septoplasty, particularly in complex cases with mucosal tears. This technique may reduce early post-operative morbidity and improve patient comfort during the initial healing phase.
This study has some limitations. The single-centre design may limit generalisability. The three-month follow-up is adequate for assessing early healing but not long-term outcomes. The PRFG preparation protocol, while effective, is more complex than standard PRF methods and requires preparation two days before surgery. The surgeon was not blinded to treatment allocation. The assessment of epithelialisation was interval-based rather than continuous, which may have resulted in minor imprecision in healing time estimation. Finally, the lack of histopathological analysis means healing mechanisms are inferred from clinical observations.
What is already known on the subject:
• Septoplasty is a common operation for nasal obstruction but carries a risk of delayed mucosal healing, crusting, synechiae and post-operative discomfort
• Platelet-rich fibrin (PRF) is an autologous biomaterial that releases growth factors to promote tissue regeneration and has shown benefit in rhinoplasty, endoscopic sinus surgery and turbinate procedures; however, evidence for its application specifically in septoplasty remains limited and largely retrospective.
What this paper adds to our understanding:
• This randomised controlled trial demonstrates that intra-operative platelet-rich fibrin glue (PRFG significantly accelerates endoscopic mucosal epithelialisation during the first two weeks after septoplasty, with no difference observed at four or 12 weeks
• PRFG reduces early post-operative pain, nasal crusting and subjective nasal obstruction during the initial recovery period, without increasing complications
• PRFG may be particularly beneficial in complex cases with intra-operative mucosal tears; however, its routine use in standard septoplasty requires further evaluation of cost and logistical feasibility
Conclusion
Intra-operative PRFG accelerates mucosal healing and reduces post-operative morbidity during the first two post-operative weeks following septoplasty, without increasing complications. These benefits are limited to the early recovery period, with no significant differences observed at four or 12 weeks. PRFG may be a safe and biologically compatible adjunct in selected complex cases with intra-operative mucosal compromise. The logistical demands of PRFG preparation should be considered when evaluating its clinical applicability.
Originality
This manuscript is original, has not been published previously and is not under consideration by another journal.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Kafr Elsheikh University IRB (Approval No: KFSIRB200-542).
Clinical trial registration
The study protocol was registered at ClinicalTrials.gov (NCT06996106).
Informed consent
Written informed consent was obtained from all participants for participation and publication of data.
Funding
No funding or financial relationships to disclose.
Competing interests
The authors declare no conflicts of interest.
