Use of Free Flaps in Palatal Fistula

Zavala A.; Pawlikowski W.D. · Surgical Atlas of Cleft Palate and Palatal Fistulae (2022) · DOI: 10.1007/978-981-15-8124-3_93

Resumen

Surgical correction of wide palatal clefts and palatal fistulae can be challenging, with multiple attempts of closure often being required. When regional or turnover flaps have undergone failure or are unable to provide enough tissue to cover the defect, microvascular tissue transfer is indicated. Depending on the defect location and the required tissue for reconstruction, different free flaps can be used to provide adequate coverage. Most wide palatal defects can, however, be reconstructed using skin flaps. Due to its versatile qualities, ease of harvest, long vascular pedicle, consistent vascular anatomy, and thin and pliable skin paddle, the radial forearm free flap is the most used free flap in these cases. The anterolateral thigh flap, a workhorse flap in head and neck reconstruction commonly used for intraoral defects, is also a reliable option to reconstruct recurrent extensive palatal fistulae. When the defect includes the velopharyngeal muscles, a superiorly based pharyngeal flap is indicated to be performed in conjunction with the free flap to provide a dynamic restoration of the velopharyngeal function. This chapter aims to provide a comprehensive approach to the use of free tissue transfer in recurrent wide palatal fistulae, describing preoperative and postoperative considerations and detailing the applications of the workhorse free flaps based on the tissue requirements. © Springer Nature Singapore Pte Ltd. 2022. All rights reserved.