The aim of this study was to assess the success of the technique of open septoplasty with bipedicled flaps in achieving long-term closure and control of symptoms. Between 1993 and 2000, 32 patients underwent surgery for nasal septum perforation. Twenty patients with large perforations underwent posterior edge repair only. The remaining 12 patients (five female, and seven male) with perforations less than 20 mm in diameter underwent open septoplasty and a unilateral bipedicled flap closure. A retrospective review involving a symptom scores assessment and follow-up examination was conducted. One patient died of unrelated illness, and was excluded. Results showed 10 of the remaining 11 patients achieved closure after a mean follow up of 10 months. The symptoms of crusting (p < 0.0001), epistaxis (p < 0.02), discharge (p < 0.012), whistling (p < 0.011), and overall discomfort (p < 0.02), were all significantly improved. We conclude that by using this technique on patients with small perforations less than 20 mm, it is possible to achieve up to a 90 per cent perforation closure rate, and a significant improvement in patients’ symptoms.