Fascia Lata Free Flap Reconstruction of Limited Hard Palate Defects

Abstract

Objective The anterior-lateral thigh (ALT) free flap is a flexible reconstructive option with fascia lata, fasciocutaneous, and musculocutaneous options. The objective of this study is to evaluate ALT fascia lata free flap reconstruction of isolated hard palate defects.Methods Retrospective chart review of all palate reconstructions with ALT free flap from 2008-2017 by a single surgeon, at a tertiary academic institution. Patients with defects limited to the hard palate were selected for review.ResultsForty-eight patients were identified, of which 14 patients had limited palatal defects repaired with fascia lata free flaps and were selected for review. The average hospital stay for all patients was 2.8 days (range 1-4 days). Eighty-five percent of patients were started on an oral diet from post-operative day (POD) one. Ten of 14 were extubated at the end of the case, with four being extubated on POD one. One patient suffered donor site morbidity, which required intervention (one seroma requiring drainage). Two patients underwent minor palatal revisions with local tissue rearrangement for recurrent fistula. No patients suffered long-term velopharyngeal inadequacy (VPI) or dysphagia, and all reported normal nasal respiration.ConclusionThe ALT fascia lata free flap is a versatile reconstructive option for hard palate defects, with minimal morbidity, short hospital stays, and excellent long-term results.

Evaluation of Anterolateral Thigh Fascia Lata Rescue Flap for Mandibular Osteoradionecrosis

“…There are several advantages to offering the ALTFL rescue flap procedure. First, donor site morbidity is low . Also, given that patients with ORN are at high risk for advanced cancer recurrence—and may require future salvage resection and reconstruction—the ALTFL rescue flap procedure is an important option because it does not preclude future fibula free flap reconstruction.…”

“…First, donor site morbidity is low. 10,11,[32][33][34][35][36] Also, given that patients with ORN are at high risk for advanced cancer recurrence-and may require future salvage resection and reconstruction-the ALTFL rescue flap procedure is an important option because it does not preclude future fibula free flap reconstruction. This procedure also does not render revision surgery more difficult or limit other options because the transoral approach to the mandible and the minimal access incision for vessels minimize the need for transcervical dissection.…”

Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft

“…The ALTFL has previously been successfully used for other complex facial defects. [11][12][13][14] In this application, the ALTFL lends itself to being an optimal reconstructive option to reestablish a barrier where needed, obliterate dead space left by tumor resection, and correct any soft tissue contour deformity or irregularity due to its thin and pliable nature. Rib bone graft success was demonstrated by no significant decrease in size or change in position on surveillance imaging, indicating successful osseointegration.…”

The vascularized fascia lata free flap: an anatomical study and clinical considerations

“…38 different cases [20][21][22][23][24]. Free fascia lata flaps were successfully described with a 97.4% free flap survival rate for recreation of mucosal lining after total or subtotal rhinectomy (n = 5) [21], reconstruction of palatomaxillary defects (n = 14) [22], extremity (n = 5) [20], and upper limb reconstruction (n = 6) [23], as well as for coverage of mandibular bone after osteoradionecrosis secondary to radiation therapy (n = 8) [24].…”

“…With regards to the harvest of a fascia lata free flap, preservation of skin and subcutaneous tissue aid in the manipulation of the flap during harvest and thus helps to avoid damage of the vascular plexus surrounding the FL and perforators [22]. A free fascia lata flap has to be incised and harvested in the required size incorporating the perforator, which is traced and dissected to the source of the pedicle creating perforators ranging from 8 to 16 cm in length with a diameter of more than 2 mm [3].…”