Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nasal septum. There are many causes for septal perforaton including prior nasal surgery ,nasal trauma , cocaine abuse ,inflammatory disorders ,infection , cancer. The mechanical closure with a prosthesis such as the septal button. Silicon buttons can alleviate epistaxis, whistling and nasal obstruction, but these prostheses cannot control the production of crusting around the margins of the button which causes discomfort for patients. The aim of this study was to evaluate endoscopic repair of cartilaginous nasal septal perforation with Alloderm and rotational flap. Patients and Methods: This is a prospective, cross sectional study and was carried out on 24 Patients (16 males and 8 females, their age ranged from 18 to 53 years) with caritlagenous septal perforation All Patients were subjected to complete history taking, complete ENT examination, high resolution computed tomography "HRCT" and complete laboratory investigations. All patients underwent endoscopic repair for the perforation of cartilaginous septum with alloderm (AlloDerm, Lifecell, USA) and rotational flap. Results: 23 cases of our pateints had complete healing with success rate (95.8%) and one case failed due to flap necrosis (4.2%). Conclusions: Endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap approach can be considered as an effective technique for septal perforation. The usage of Alloderm, has the advantages of decreasing morbidity ,suitable for all perforations sizes and acting as an excellent scaffold for re-epithelization, but with high costs. The septal flap provide a good vascularity for good healing .