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Repair of Recalcitrant Palatal Fistulas with Free Flaps
Payam Sadeghi, Andrea Sisti, Kenneth Lawrence, Francis Papay, Antonio Rampazzo, Bahar Bassiri Gharb
Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
2020-02-15
Presenter: Payam Sadeghi
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND-Reconstruction of large oronasal fistulas (ONF) in bilateral cleft lip and palate (BCLP) patients is challenging. Traditional repair techniques often fall short and have high recurrence rates. Microsurgical reconstruction could be an option to achieve healing in these patients.
METHODS-A retrospective study was conducted including BCLP patient that underwent reconstruction of palatal fistulas using free flaps, from 2014 to 2019. Age, sex, number of previous repair attempts, ONF type according to the Pittsburgh Fistula Classification System, free flap type, recipient vessels, further procedures, complications and follow-up were collected.
RESULTS-Four patients were included (three females and 1 male). Age ranged between 7 and 29 years. There were 3 ONFs type 3, 1 type 4 and 1 type 5. Median number of attempts to repair the fistula was 2 (IQR=4.25). All patients underwent two-layer reconstruction of the fistula with mucoperiosteal turn-over flaps and radial forearm free flap (RFFF); 1 osteocutaneous and 3 fasciocutaneous. The recipient artery was facial artery. The recipient vein was facial vein (FV) in 3 cases and external jugular vein (EJV) in one case. Vein grafts were employed in 2 cases to reach FV (at origin) and EJV. The average follow-up was 21.3 months. Flap debulking was necessary to fit partial dentures, in one case. Iliac crest cancellous bone graft was successfully performed in two patients at mixed dentition. In one patient the tricortical iliac crest bone graft failed. No fistula recurrence occurred.
CONCLUSIONS-Two-layer reconstruction with RFFF of the large oronasal fistulas in BCLP patients can provide stable healing.
