Use of Osteocutaneous Second-Toe Free Flap for Anterior Oronasal Fistulas

Abstract

Palatal fistula is a known complication of cleft lip-cleft palate repair. Fistulas anterior to the incisive foramen can be particularly difficult to repair because of the lack of available tissue. Adjacent tissue has inherent limitations, and multiple free-flap techniques have been described; however, there remains no single solution for this difficult problem. The authors present an alternative strategy of replacing "like with like" by using an osteocutaneous free tissue transfer of the second toe for anterior oronasal fistulas. Use of the osteocutaneous second-toe free flap provides skin lining to both the oral side and the nasal side to close oronasal fistulas. It also bridges the alveolar gap with vascularized bone. This flap can be considered as an elegant alternative for anterior oronasal fistulas.

Persistent symptomatic anterior oronasal fistulae in patients with Veau type III and IV clefts: A therapeutic protocol and outcomes

“…16 , 21-23 However, the reconstruction of a particular cohort composed of patients with persistent symptomatic anterior oronasal fistulae has only been sporadically reported. [11][12][13][14][15][16][17] Previous studies have included small and/or mixed samples (e.g., only patients with anterior hard palatal fistulae or patients with all Pittsburgh II to VII types, with no specific stratification of fistulae neighboring to the alveolar cleft), which limit the interpretation and/or comparison of described experiences and results. In this study, we reviewed the long-term experience of a single senior surgeon with a therapeutic protocol for the surgical management of persistent symptomatic anterior oronasal fistulae in patients with Veau type III and IV clefts.…”

“…[7][8][9] Oronasal fistula reconstructions by adopting myriad surgical techniques (e.g., local flaps, regional intraoral or extraoral flaps, and free flaps) have been widely addressed in cleft literature, [7][8][9] but the surgical management of persistent anterior oronasal fistulae (Electronic supplementary material 1) neighboring the alveolar cleft (i.e., the Pittsburgh classification type V to VII fistulae 10 ) has only been sparsely reported in sporadic cases. [11][12][13][14][15][16][17] The diagnosis and treatment of patients with persistent anterior oronasal fistulae should be distinguished from the commonly detailed surgical approach of oronasal fistulae characterized as complications of post-cleft palate repairs (i.e., the Pittsburgh classification type I to IV fistulae). 10 In our experience, persistent anterior oronasal fistulae are particularly challenging to repair, as this subgroup of patients is distinct from those who usually have been followed up within our standard cleft protocols.…”