Why does cocaine use after repairing a septal perforation guaranteed to cause another perforation?

The health of any tissue is related to the blood supply. Cocaine decreases the blood supply to the tissue. Would occasional use of cocaine every six months or so definitely cause the perforation to form again? Not necessarily, but you would be CRAZY to take that risk! Please do not use cocaine ever, but definitely do not do it after a septal perforation repair. It is not worth the risk!

If you are going to continue using the drug that caused the problem in the first place, I would strongly advise  you to not have the procedure as it will most certainly not be successful. This means ANY use of the drug at all.  Large amounts or small amounts. Whether saline spray is used or not.

This is one of the most challenging or all nasal procedures. The repair if successful will be weaker than the original septum.  Rinsing with saline will not prevent the damage. Re-using would be a reckless decision

Cocaine is a vasoconstrictor...meaning that it makes blood vessels shrink up.  Cocaine is so good that we actually use cocaine in surgery to stop bleeding and provide for anesthesia.  The reason you got the perforation in the first place is that usage of cocaine caused a ischemic (lack of blood flow) damage to the septum, which eventually caused a perforation as the tissue died with loss of blood.  Repair of such perforations is difficult because the surrounding tissues are friable and have sustained some of the same damage.  In essence you are moving less damaged tissue to cover a very damaged area.  Use of cocaine following repair is almost guaranteed to cause this less damaged tissue to die.

Cocaine is a vasoconstrictor meaning it decreases blood flow. Decreasing blood supply to an area which is already compromised after surgery will lead to further tissue breakdown. Regards,Dr. Michael Sullivan Sullivan Centre