FREE-FLAP CLOSURE OF RECURRENT PALATAL FISTULA IN THE CLEFT-LIP AND PALATE PATIENT

Recurrent palatal fistulas present a particularly vexing problem far t he cleft surgeon. In this setting, the cycle of repair followed by bre akdown results in increasing scar formation with associated soft tissu e contracture and a resultant increase in fistula size. This perniciou s cycle of events renders random local tissue transfers obsolete. As s uch, the cleft surgeon must look to tongue flaps or local axial patter n flaps as a means of bringing well-vascularized, pliable tissue into the defect. Although this approach has been the standard of care for t he last few decades, we believe that the modern-day success rates of f ree tissue transfers (95%) make them a viable, one-stage means of clos ing these defects. In this report we present our clinical experience w ith recurrent palatal fistulas and highlight the effective use of the dorsalis pedis-first dorsal metatarsal artery free flap as a means of repair.