Outcomes of facial artery musculomucosal flap for closure of small and medium sized fistula after clefts

Abstract

Aim of the workThe aim of the present study is to evaluate the use of FAMM for closure of small and medium sized fistula regarding reliability, success rates and associated complications and to present a 2 years follow up for patients reconstructed by FAMM flap technique. Patients and methodsThis prospective study was carried out during the period from June 2014 to June 2016 on 24 children; 10(41.66%) boys and 14 (58.33%) girls, attending the outpatient clinic of pediatric surgery department, Al-Azhar University hospitals. Their ages ranged from 2 to 9 years with a mean 4 ± 2 years. All patients were complaining from palatal fistula after palatoplasty due to cleft palate. Written consents were taken from all patients of the children. All patients were subjected to FAMM flap technique. Data regarding surgical technique, success rate and complications were recorded with a 2 years follow up for those patients. ResultsThe fistulas were between 2 and 5 mm in size (small and medium sized). 9(37.5%) were having small fistula (<2 mm) and 15 (62.5%) were having medium sized fistula (5–10 mm). The anterior palatal fistula [14 (58.33%) patients] were reconstructed by superiorly based buccinator flap while fistula at the junction of the soft and hard palate [10 (41.66%) patients] were reconstructed by inferiorly based flap. Satisfactory closure of the fistula was achieved in all patients except in one patient (4.16%). 3 flaps (12.5%) developed venous congestion and resolved spontaneously without any active intervention. One flap (4.16%) developed suture line dehiscence. Flap revision was necessary. Differences in flap patterns, fistula location and size of palatal defect has no significant effect on flap survival. ConclusionFAMM flap is appropriate for reconstruction of small and medium sized fistula because of its reliability and versatility. The flap presents few complications and ensures adequate functional results after palatal fistula repair because of its nearly the same tissue like the palatal tissue.