Flap necrosis after palatoplasty in irradiated patient and its reconstruction with tunnelized-facial artery myomucosal island flap

Abstract

BackgroundTunneled transposition of the facial artery myomucosal (FAMM) island flap on the lingual side of the mandible has been reported for intraoral as well as oropharyngeal reconstruction. This modified technique overcomes the limitations of short range and dentition and further confirms the flexibility of the flap. This paper presents a case of reconstructing secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in irradiated patient with lingually transposed facial artery myomucosal island flap.Case presentationThe authors successfully reconstructed secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in an irradiated 59-year-old female patient with tunnelized-facial artery myomucosal island flap (t-FAMMIF).ConclusionsIslanding and tunneling modification extends the versatility of the FAMM flap in the reconstruction of soft palatal defects post tumor excision and even after radiation, giving a great range of rotation and eliminating the need for revision in a second stage procedure. The authors thus highly recommend this versatile flap for the reconstruction of small and medium-sized oral defects.

Facial Reconstruction Using Facial Artery Myomucosal Flap: A Comprehensive Review

“…Contraindications for using the FAMM flap include a compromised or absent facial artery, as the flap relies on the blood supply provided by the facial artery [ 34 ]. Additionally, patients with a history of radiation therapy in the area may have compromised vasculature, which can pose a risk to flap survival [ 37 ]. Oncologic safety is another consideration, as the FAMM flap should not be used in cases where there is a risk of transferring malignant cells from the donor site to the recipient site [ 12 ].…”

“…The author explained that this method can offer an effective way to reconstruct medium-sized, full-thickness cheek defects by using tissue similar to the one lost, and with little to no harm to the donor site [ 38 ]. The versatility of the FAMM flap in reconstructing soft palatal defects after tumor removal or radiation is enhanced by islanding and tunneling modification, which provides a greater range of rotation and eliminates the need for a second-stage revision procedure [ 37 ].…”

“…2017 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0 /), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made [ 37 ]…”