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Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing following Furlow Palatoplasty

Qiu, Cecil S., B.A.; Fracol, Megan E., M.D.; Bae, Hanah, B.S.; Gosain, Arun K., M.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 1179–1183
doi: 10.1097/PRS.0000000000005430
Pediatric/Craniofacial: Ideas and Innovations
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Summary: Furlow palatoplasty is increasingly used both for primary palatoplasty and for secondary correction of velopharyngeal insufficiency. Although Furlow palatoplasty offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal Z-plasty flap, with superficial separation of the oral mucosa observed in up to 53 percent of cases of secondary Furlow palatoplasty. To mitigate this problem, the authors prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal Z-plasty flap. The authors report their experience comprising seven patients who underwent Furlow palatoplasty with buccal fat flap augmentation. Four of these patients had secondary Furlow palatoplasty procedures; one of them experienced oral mucosal separation that healed uneventfully. No patients developed an oronasal fistula. The authors’ experience suggests that buccal fat flaps may minimize vascular compromise and dehiscence of the oral mucosal Z-plasty following Furlow palatoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Chicago, Ill.

From the Division of Plastic Surgery, Lurie Children’s Hospital of Northwestern Feinberg School of Medicine.

Received for publication March 29, 2018; accepted September 6, 2018.

Disclosure: The authors have no financial information to disclose in relation to the content of this article.

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Arun K. Gosain, M.D., Division of Plastic Surgery, Lurie Children’s Hospital, 225 East Chicago Avenue, Box 93, Chicago, Ill. 60611, argosain@luriechildrens.org

©2019American Society of Plastic Surgeons