The folded radial forearm flap in soft-palate and tonsillary fossa reconstruction: technical note

Excision of the tonsillary fossa and soft palate leaves functional sequelae unless followed by a well-planned reconstruction phase. This must aim at restoring the pharyngeo-palatal structure, covering the dissected surfaces, and restoring continuity to the lingual and inferior alveolar nerves when these are sectioned. A reconstruction model of this complex three-dimensional anatomical area is proposed that uses a microvascular fasciocutaneous forearm flap adapted to the individual patient. Twelve patients were operated on, following this model. All flaps survived intact. Velopharyngeal function was optimal in 11 cases (92%), suboptimal in 1 case. Patients also achieved good functional recovery (speech, swallowing and chewing). Careful three-dimensional planning of reconstruction for the tonsillary and soft-palate area makes it possible to restore velopharyngeal function to levels close to the preoperative situation.