Reconstruction of Wide Cleft Palate or Recurrent, Large Fistula with Radial-Forearm Free Flap: Ten Years Results in 17 Patients

Cleft Palate is the most common congenital craniofacial disorder with prevalence about one in every 2000 births. In most of these patients, local and regional tissues in the mouth are used to repair it. However, in cases of wide cleft palate or large and recurrent fistula, these methods are not efficient and require the transfer of free flaps. In this retrospective study, records of 17 patients with cleft palate or palatal fistula that treated with free flaps were studied. The information includes age, sex, cause of surgery, type of transferred flap, recipient artery and vein, size of skin paddle, pre-laminate or graft coverage of nasal side, early flap survival, long-term results, effects on nasal regurgitation and velopharyngeal insufficiency were collected. Data were analyzed by SPSS software version 19 and using descriptive statistics. The mean age of patients was 13.540 ± 15.705 (3-54 years). 10 (60%) were male and 7 (40%) were female. 8 (47%) patients were operated due to wide cleft palate (WCP), 7 (41%) patients due to recurrent palatal fistula (PF), one (6%) patient due to extensive tumor resection and one (6%) patient due to extensive defect followed by Mucormycosis fungal infection in a diabetic patient. All the flaps survived, and complete or partial necrosis were not observed. Nasal Regurgitation was cured in all but three patients and Velopharyngeal insufficiency (VFI) was improved in all patients. Radial Forearm Free Flap is one of the best choices to cover the defect in patients with a wide cleft palate or a recurrent or large palatal fistula. In our study, the success rate was 100%, however, in about 18% of patients, there was complications that needed another operation. The most important disadvantage of this flap is the unaesthetic scar of forearm, which should be placed against its great benefits.