Two-flap technique with interpositional dermofat graft for anterior oronasal fistula closure in patients with cleft: A case series

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2024-03, Vol.90, p.51-59
• Main Authors: Hattori, Yoshitsugu, Tu, Junior Chun-Yu, Chou, Pang-Yun, Lo, Lun-Jou
• Format: Article
• Language: English
• Subjects: Cleft Lip - surgery; Cleft lip and palate; Cleft Palate - complications; Cleft Palate - surgery; Dermofat graft; Fistula - etiology; Fistula - surgery; Humans; Interposition graft; Nose - surgery; Nose Diseases - etiology; Nose Diseases - surgery; Oral Fistula - etiology; Oral Fistula - surgery; Oronasal fistula; Quality of Life; Retrospective Studies; Surgical Flaps; Two-flap technique
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2024.01.012

Oronasal fistula at the anterior hard palate is one of the common sequelae after cleft surgery, and the leakage negatively affects the patient’s quality of life. Although several surgical techniques have been proposed for reconstruction, it remains challenging because of the scarred regional tissue with a high rate of fistula recurrence. In this study, we present the anterior oronasal fistula repair using a two-flap technique with an interpositional dermofat graft (DFG). A retrospective review of anterior oronasal fistula repair performed by the senior author between April 2018 and August 2022 at the Craniofacial Center was conducted. Patients who underwent a fistula repair using the technique were further identified and investigated. Thirty-four operations were performed using the technique, and 31 fistulas were completely closed, with a success rate of 91.2%. The fistula symptom improved but persisted postoperatively in 3 patients, of whom 2 patients underwent a second fistula repair using the same procedure, resulting in successful closure. Fistula recurrence was significantly correlated with fistula size (p = 0.04). The DFG was simultaneously utilized for nasal dorsum and/or vermillion reconstruction in 28 cases. The two-flap technique enabled tension-free approximation, and the interpositional DFG facilitated watertight closure of the fistula, resulting in a high success rate of anterior oronasal fistula repair. The fistula closure could be combined with other revisional procedures for cleft-related deformities, where the DFG was simultaneously utilized.