Septal perforation repair can be challenging, especially for larger perforations without cartilage support. The document reviews techniques for endoscopically repairing septal perforations using flaps based on the size, location, available cartilage, and other patient factors. Completely closing the perforation without tightness and preserving blood flow are the most important factors for avoiding recurrence, and changing the flap if needed can help ensure a successful repair and prevent failure.