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Updated: Oct 5, 2025
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Two-Layer Palatal Reconstruction Reduces Postoperative Intraoral Complications in Head and Neck Surgery
Hitoshi Nemoto1, David Chon-Fok Cheong1, Shao-Yu Hung1
1From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University; Department of Plastic and Reconstructive Surgery, Tokai University Hospital; and Center for Tissue Engineering, Chang Gung Memorial Hospital.
Background:
Although microvascular free flaps are commonly performed and have high success rates, postoperative oronasal fistulas or infections do occur. The authors hypothesized that a two-layer closure is effective for prevention of intraoral complications.
Methods:
Patients who underwent palatal reconstruction with a microvascular free flap were evaluated retrospectively. The cases were divided into two groups (palatal reconstruction with or without a two-layer closure). A two-layer closure involves unilateral reconstruction with a free flap, then reconstruction of the nasal lining with a local flap or folding free flap. The postoperative complication rates between these two groups were compared.
Results:
One hundred fifty-five cases were evaluated. A two-layer closure was performed in 65 cases (41.9 percent). The incidence of infections, dehiscence of the recipient site, and oronasal fistula were significantly higher in the single-layer closure group than in the two-layer closure group [10.0 percent versus 0 percent (p = 0.011); 15.6 percent versus 4.6 percent (p = 0.036); and 17.8 percent versus 4.6 percent (p = 0.013), respectively].
Conclusions:
A two-layer closure in palatal reconstruction was shown to reduce the rate of infection, intraoral wound dehiscence, and oronasal fistula in the current study. A two-layer closure provides greater support and stability and reduces the risk of failure in reconstruction of the palate with a microvascular free flap.
Clinical Question/Level Of Evidence:
Therapeutic, III.
