Flap Necrosis after Palatoplasty in Patients with Cleft Palate

Abstract

Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate.

Cleft Lip and Palate Repair Using a Surgical Microscope

“…As Sommerlad et al [ 4 ] reported, the margins between the muscle and mucus are easily detectable under a microscope; therefore, precise procedures are possible. Experienced surgeons cause fewer surgical complications than beginning surgeons when using surgical loupes [ 5 - 7 ]; however, in our series of cases, the surgeon who operated on group M, with 1 year of experience, had the same complication rate as the experienced surgeon who operated on group L [ 8 ]. Microsurgical procedures may be helpful for reducing the complication rate due to the ability to make precise maneuvers.…”

Correction of through defects of the palate and alveolar process of the upper jaw using facial artery musculomucous flap

“…Согласно нашим собственным наблюдениям и данным литературы [8], осевые небные лоскуты удобны для устранения небольших и средних дефектов заднего отдела неба, в случае небольших и средних дефектов переднего и среднего отделов твердого неба приоритетным методом является щечный слизистомышечный лоскут.…”

“…Что касается возможных осложнений, согласно данным литературы [8], 8,3% составил частичный некроз лоскута, что в последующем не повлекло рецидивирования дефекта. В своей практике в 2 (11,1%) из 18 случаев мы наблюдали ишемию концевой части лоскута, в течение 6-7 дней после операции цвет концевого участка лоскута восстанавливался до нормы, что не повлияло на успешный результат операции.…”

Primary Cheiloplasty using the Technique of Millard

“…Aiming the growth and development of the craniomaxillofacial complex, as well as the perfect execution of the tasks of the stomatognathic system (phonation, swallowing, irruption of the dental elements), it is necessary multidisciplinary approach, seeking early treatment and better resolution of the case, which will last until adulthood [3,[11][12][13][14].…”