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Reverse Flow Nasolabial Flap for Reconstruction of Palatomaxillary Defects: A Surgical Innovation and Outcomes
Sasi Krishna Kavutarapu1, BhanuPrakash Bylapudi2, Koilada Shiv Kumar3
1Associate Professor, Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital & Research Centre, A Unit of Tata Memorial Centre, Visakhapatnam, Andhra Pradesh, India; Associate Professor, Department of Atomic Energy, Govt. of India, Homi Bhabha National Institute (HBNI), Visakhapatnam, Andhra Pradesh, India.
Abstract:
Palatal and maxillary defects after oncologic resection impair speech, swallowing, and cosmesis. The reverse flow nasolabial (RFNL) flap, based on the angular artery, is a reliable and versatile choice for restoring function and reasonable aesthetics. This technical note describes our experience and outcomes with RFNL flap from a tertiary cancer center in South India. Between January 2022 to May 2023, 30 patients underwent reconstruction using 40 RFNL flaps. One patient (3.34%) had partial flap loss. While the facial scar healed well in 83% of patients, 17% developed a hypertrophic scar. Grade II oral incompetence was noted in 4 patients (13%). Deviation of angle of the mouth was obvious in 3 (10%) and slight in 12 (40%). None of the patients experienced venous congestion, wound dehiscence, parotid duct injury, or donor-site recurrence. The RFNL flap is easy to harvest, close to surgical site, and versatile for palatal defect reconstruction. Patients should be counseled on potential facial scarring, commissure deviation, and minimal risk of oral incompetence.
