Summary: Large oronasal palatal fistulas can be challenging to reconstruct. The authors present a modified buccal myomucosal flap repair technique and review intermediate-term outcomes. In this technique, large anterior palatal fistulas are closed in two layers. First, apposing nasal turnover flaps of vomer mucosa medially and nasal wall mucosa laterally are approximated. Second, a posteriorly based buccal flap incorporating full-thickness buccinator muscle and overlying mucosa is transposed with interposition of the flap in the retromolar trigone and lateral palate to preserve dental occlusion. Consecutive patient cases performed in low-resource settings were reviewed and outcomes reported. Among eight subjects aged 3 to 22 years, with average defect size of 2.5 cm2 (range, 0.8 to 3.5 cm2), the flap was viable in all cases and required revision or pedicle division in only two patients (25 percent); all patients showed symptom improvement. The modified buccal myomucosal flap shows promising intermediate-term results as a single-stage reconstruction suitable to a wide patient age range, low airway/anesthetic risk, reliable functional outcomes, and low comorbidity.

Background: Abdominoplasties are increasingly requested aesthetic, reconstructive surgical procedures that, in most cases, have shown the disadvantage of leaving an often-notorious periumbilical scar due to hypertrophy, keloid, or because it simply remains very visible over time, after surgery. The Alvarez technique (or nonscarring minimal-incision neo-omphaloplasty) is a completely new, unprecedented technique because it does not leave visible scars. This technique requires the generation of four small flaps and a purse-string suture system interacting with the aponeurosis of the rectus abdominis muscles, as well as the modification of the vertical abdominal plication, and management of the subcutaneous cellular tissue in the new umbilicus area, which, if executed correctly, provide adequate aesthetic results. Methods: A multicentric case-series scientific study is presented with a total of 94 patients who underwent classical abdominoplasties and neo-omphaloplasties with the aforementioned technique from August 2018 to December 2020. Pre-surgical and postoperative photographic files were collected. Results: Of the 94 patients, there were eight (8.5%) cases of seroma, which are not attributable to neo-omphaloplasty but inherent to the use of drains. There were five (5.3%) cases of umbilical dehiscence. In total, 89.2% (84 patients) showed a very high degree of long-term satisfaction, and 10.6% (10 patients) had a medium level of long-term satisfaction. Conclusions:The Alvarez technique provides good aesthetic results that are well accepted among patients and surgeons, in the short and long term. It is useful for those patients who wish to undergo an abdominoplasty but cannot stand a scar in the umbilical region.

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