Cleft palate fistula closure with a mucosal prelaminated lateral upper arm flap.
BACKGROUND
Recurrent cleft palate fistula is a challenge for maxillofacial surgeons. In severe cases, microvascular tissue transfer is necessary to treat these patients successfully.


METHODS
A 23-year-old man with cleft lip and palate, previously treated elsewhere, presented with a 2-cm defect in the posterior hard palate. A tongue flap had already been performed. It was decided to close the persistent fistula with a lateral upper-arm flap. In a first-step operation, a free graft of buccal mucosa was fixed to the lateral upper arm subcutaneously and covered with an alloplastic sheet. After 11 weeks, the prelaminated flap was harvested and transferred to the palate.


RESULTS
Integration of the buccal mucosa to the upper arm was uneventful. On harvesting the flap, we found a smooth, thin, and continuous fasciomucosal flap with a mucosa surface of 4 x 4 cm. Healing of the microvascular flap in its recipient site was regular. The fistula was closed successfully.


CONCLUSIONS
To the authors' knowledge, this is the first report of a lateral upper-arm flap prelaminated with autologous mucosa. By prelamination, it is possible to circumvent the disadvantage of extraoral skin within the oral cavity and to cover mucosal defects with mucosa, especially in elective procedures, such as cleft cases.
Krimmel
Michael
M
Department of Oral and Maxillofacial Surgery, University Hospital, Tübingen, Germany. michael.krimmel@med.uni-tuebingen.de
Hoffmann
Jürgen
J
Reinert
Siegmar
S
D000328:Adult; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D016155:Oral Fistula / Q000209:etiology / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods; D012008:Recurrence; D013524:Surgical Flaps