With the progress of society and the improvement of living standards, people have become more profoundly aware of the quality of life and health, and the concept of early detection, early diagnosis and early treatment of relevant diseases has taken root in people’s hearts. Nasal septal surgery has become the most basic and routine surgery commonly performed in hospitals at all levels. In previous scientific articles we have mentioned some cases of septal surgery, such as simple septal correction, septal surgery with simultaneous sinus opening and nasal-sinus tumor resection, etc. So, are we clear about what conditions need to be paid attention to in order to effectively prevent the surgery from causing perforation and avoid the adverse consequences of perforation? As we know, the nasal septum is the partition between the bilateral nasal cavities and is made of cartilage (nasal septal cartilage) and bone (vertical plate of sieve bone, plough bone, nasal crest of maxilla, etc.), which is covered with cartilage membrane, periosteum and nasal mucosa. During septal surgery, the deviated bone or cartilage needs to be removed, leaving the soft tissue (bone/chondroperiosteum and mucosa) as intact as possible. If too much soft tissue is damaged while removing the septum, there is a risk of postoperative septal perforation. Especially if there is a symmetrical bilateral soft tissue defect and the operator fails to make the necessary repairs in time, perforation is often inevitable. In order to avoid septal perforation, the surgeon needs to make a comprehensive and systematic assessment of the patient’s general condition and nasal lesions before surgery, especially an accurate judgment of the nature of septal deviation and mucosal thickness. Adequate preoperative estimation helps the surgeon to focus on the protection of the mucosa in critical areas during surgery. Theoretically, complete preservation of the soft tissue of the septum bilaterally is the key to avoiding septal perforation. If there is a defect in the mucosa on one side, but at least the soft tissue on the other side (usually the concave side) should be kept intact. If there is a bilateral mucosal defect, especially if it is symmetrical, timely intraoperative repair is important. A septal cartilage slice or bone slice (larger in area than the defect) can be chosen to be sandwiched between the soft tissues of the defect area for repair. In addition, nasal stuffing is one of the factors that should not be neglected. Excessive forceful stuffing and compression can affect the blood supply to the mucosa of the septum, which may induce septal perforation. Therefore, postoperative nasal stuffing should be appropriate, for example, one piece of expansion sponge for each bilateral nasal cavity is sufficient.