title: Repair of cocaine-related oronasal fistula with forearm radial free flap.
abstract: BACKGROUND
  Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions.
  
  
  METHODS
  From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication.
  
  
  RESULTS
  In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved.
  
  
  CONCLUSIONS
  Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness.
authors.affiliation: From the Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
authors.forename: Fabiana
authors.initials: F
authors.lastname: Allevi
authors.forename: Davide
authors.initials: D
authors.lastname: Valassina
authors.forename: Dario
authors.initials: D
authors.lastname: Bertossi
authors.forename: Federico
authors.initials: F
authors.lastname: Biglioli
mesh_terms: D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D005260:Female; D005542:Forearm; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D009668:Nose Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery*; D016155:Oral Fistula / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003042:Cocaine