Modified VIP-CT flap in late maxillary alveolar cleft surgery

Area of Science:

• Craniofacial surgery
• Reconstructive surgery
• Oral and maxillofacial surgery

Background:

• Maxillary alveolar clefts often present complex challenges for bone grafting, particularly in late-stage reconstructions.
• The modified vascularized interpositional periosteal-connective tissue (VIP-CT) flap is a surgical technique explored for addressing these challenges.

Observation:

• The study involved thirteen patients (seven female, aged 12-25) with maxillary alveolar clefts requiring bone grafting, often associated with missing anterior teeth.
• The modified VIP-CT flap was utilized for bone graft coverage in these patients, with some cases requiring bilateral flaps for wider clefts or specific closure needs (nasal and oral).
• Patient histories included isolated alveolar clefts or previously operated cleft lip and palate conditions.

Findings:

• The modified VIP-CT flap demonstrated successful application in providing coverage for bone grafts in patients with late maxillary alveolar clefts.
• The technique was effective in both unilateral and bilateral complete cleft lip and palate patients, including adults.
• Donor site morbidity was evaluated, suggesting the flap's viability for reconstructive purposes.

Implications:

• The modified VIP-CT flap presents a viable and successful option for complex maxillary alveolar cleft reconstructions in adult patients.
• This technique expands reconstructive possibilities for challenging cases, including those with significant cleft width or prior surgical interventions.
• Further research may explore long-term outcomes and optimize donor site management for the modified VIP-CT flap.