Soft-palate reconstruction with a "SCARF" superior-constrictor advancement-rotation flap

Reconstruction of hemi-soft-palate defects after tumor resection is usually done by means of a regional flap, free-tissue transfer or a prosthesis. These options vary in complexity and have a number of shortcomings. A local myomucosal flap was designed that employs a superior-constrictor advancement-rotation flap (SCARF) to achieve circumferential closure of the velopharynx and to re-establish its valvular sphincteric function. Ten patients underwent a SCARF reconstruction of the velopharynx after 35% to 65% of the soft palate was resected. All patients re-established normal velopharyngeal function without significant phonatory or deglutitive disability. Two patients did require a second-stage reinforcement of the suture line after partial dehiscence. The SCARF reconstruction of the soft palate is simple, fast, and reliable and there is no significant donor site morbidity. Patients resume oral intake earlier than standard reconstructive approaches. The SCARF can be done transorally, which allows for primary resection and discontinuous neck dissection. These factors facilitate short hospitalization and effective use of resources.