Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients

Area of Science:

• Plastic Surgery
• Oral and Maxillofacial Surgery
• Reconstructive Surgery

Background:

• Palatal defects arise from oronasal fistulas in cleft patients or tumor ablation.
• While free flap reconstruction is established for tumors, its use in cleft patients is less documented.
• Previous reconstructive attempts were unsuccessful in all three patients.

Purpose of the Study:

• To describe the experience with free flap reconstruction for recalcitrant palatal defects in cleft patients.
• To evaluate a novel modification for tensionless inset of the free flap pedicle.

Main Methods:

• Three consecutive cleft patients (2 male, 1 female; ages 20-23) with recalcitrant palatal defects underwent free flap surgery.
• Radial forearm flap was used for oral lining reconstruction.
• A modified flap design with a linked skin tail was employed in two patients for tensionless pedicle coverage.

Main Results:

• One patient experienced mucosal swelling with traditional pedicle inset (mucosal tunneling).
• One patient had spontaneous, self-limiting bleeding from the flap's anterior side.
• All flaps survived without anastomosis issues or further complications.

Conclusions:

• Incision of the mucosa offers better surgical exposure and bleeding control than tunneling.
• The modified flap design facilitates tensionless pedicle inset and coverage, proving beneficial and reliable.