[Two-stage reconstruction of extensive palatal defects using a prefabricated radial forearm flap with bilateral epithelialization].

OBJECTIVE

To present and evaluate the effectiveness, safety, functional and aesthetic outcomes of the two-stage method of reconstruction of extensive through defects of the hard and soft palate.

MATERIAL AND

METHODS

The study included 5 patients with extensive defects of the palate.: subtotal defect of the hard palate - 2 patients; combined defect of the hard palate and the alveolar process of the upper jaw - 2 patients; total defect of the hard and soft palate with resection of the upper jaw - 1 patient. At the first stage (prefabrication), a standard radial skin-fascial flap on a vascular pedicle was formed on the forearm. Two separate split skin grafts taken from the thigh were placed on the muscular bed of the forearm. At the second stage, the prefabricated bilateral flap was transferred to the oral cavity with the application of microvascular anastomoses. One epithelized surface was fixed to the nasal or naso-antral side of the defect, and the other to the oral side.

RESULTS

In all 5 patients, the flaps were completely accepted (100%). There was no recurrence of the naso-oral communication in any case. Nasofibroscopy on the 21st day showed airtight separation of the cavities in all patients. Complications in the form of necrosis of the transplant sites or stricture of the feeding leg were not noted. Functional results: restoration of normal oral nutrition (14-18 days after the second stage), absence of nasopharyngeal reflux, satisfactory speech (nasal tint eliminated in 4 out of 5).

CONCLUSION

The two-stage method with pre-fabrication of the forearm skin-fascial flap effectively solves the problem of reconstruction of extensive defects of the hard and soft palate. This technique provides a bilateral mucosal lining, high graft survival rate, and restoration of chewing and speech functions without the formation of fistulas, which significantly improves the quality of life for patients. This technique is recommended for use in specialized maxillofacial surgery clinics.