Free flap closure in complex congenital and acquired defects of the palate

Extensive palatal defects cause substantial morbidity, including nasal regu rgitation, poor oral hygiene, loose-fitting obturators, and difficulty with speech. Microvascular techniques allow the surgeon to repair these complex defects with a one-stage reconstruction, in contrast to possible multistag e local or regional flap reconstruction. In this retrospective review, the authors present their 5-year experience with free flap coverage of extensiv e palatal defects, From 1993 to 1998, 6 patients underwent free flap covera ge of large palatal defects. The etiology of the large palatal defects incl uded trauma (N = 1), neoplasm (N = 4), and a recurrent congenital cleft pal atal fistula (N = 1), Three patients underwent osteocutaneous radial forear m flaps and 1 patient underwent a fasciocutaneous radial forearm flap. The remaining 2 patients underwent rectus abdominis muscle flaps. The ipsilater al facial artery and vein were used as the recipient vessels in all patient s. There were no intraoperative complications (surgical or anesthetic). Pos toperatively, 2 patients had surgical evacuation of small flap hematomas. O ne patient underwent revision of the fasciocutaneous flap. All flaps surviv ed. In our experience, the benefits of free flap reconstruction of complex palatal fistulas seem to outweigh the risks of the operation, with reliable longterm results.