Local and regional flap reconstruction of large palatal fistulae - outcomes and insights from a retrospective cohort of 129 patients.
Publication/Presentation Date
5-7-2026
Abstract
BACKGROUND: Large palatal fistulae (> 2 cm) following primary palatoplasty represent an increasingly challenging subtype, causing substantial morbidity, including oronasal regurgitation, hypernasality, and reduced quality of life. Local and regional flap reconstruction remains the mainstay of surgical management for these defects across the majority of cleft centers worldwide. This study reports outcomes of local and regional flap techniques for large palatal fistulae, with a focus on recurrence, speech outcomes, and technique selection.
METHODS: We performed a retrospective cohort study at CLAPP Hospital, Lahore, Pakistan, from January 2022 to December 2024. Patients with large palatal fistulae (>2 cm) managed exclusively with local or regional flaps were included. Fistulae were classified using the Pakistan Comprehensive Fistula Classification. Univariate and multivariate logistic regression analyses were used to identify factors associated with recurrence.
RESULTS: A total of 129 patients were included; mean age was 10.04±7.85 years. Bardach redo-palatoplasty was used in 53.5%, buccinator myomucosal flap in 22.5%, tongue flap in 12.4%, and buccal sulcus myomucosal flap in 11.6% of cases. Overall recurrence occurred in 20 patients (15.5%). Combined local flap procedures were independently associated with lower recurrence on multivariate analysis (aOR 0.20, p=0.04). Postoperatively, 86.1% of assessed patients achieved normal or mild resonance (G0/G1), with the mean composite speech score improving from 15.2 to 6.4.
CONCLUSION: Local and regional flap reconstruction achieves encouraging outcomes in large palatal fistula repair and should be regarded as the primary reconstructive strategy for large palatal fistulae.
Volume
118
First Page
1
Last Page
8
ISSN
1878-0539
Published In/Presented At
Daiem, M., Bajwa, H., Irfan, S., Ghallu, M. Z., Bashir, M. M., Haq, A., Nawfal, F., Miles, M. G., Jerrahy, R., Alonso, N., & Fayyaz, G. Q. (2026). Local and regional flap reconstruction of large palatal fistulae - outcomes and insights from a retrospective cohort of 129 patients. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 118, 1–8. Advance online publication. https://doi.org/10.1016/j.bjps.2026.04.031
Disciplines
Medicine and Health Sciences
PubMedID
42161164
Department(s)
Department of Surgery
Document Type
Article