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Beitragstitel Free-flap for Soft Palate Reconstruction, a New Approach for the In-setting
Beitragscode P05
Autor:innen
  1. Laurence Pincet CHUV Lausanne, Université de Lausanne Präsentierende:r
  2. Christian Simon CHUV Centre Hospitalier Universitaire Vaudois (CHUV)
  3. Karma Lambercy CHUV Centre Hospitalier Universitaire Vaudois (CHUV)
Präsentationsform Poster
Themengebiete
  • Innovation und Zukunftsentwicklung in der ORL
Abstract-Text Objectif
The soft palate (SP) has a complex anatomy and physiology for deglutition, breathing, sneezing, and phonation. Reconstruction after tumor resection is a challenge, and procedures that only restore bulk don't give good results(1)(2). We aim to present a new technique for the in-setting.

Procedure
We use mainly antebrachial (AB) flaps (F), but anterolateral thigh F can be an alternative. In case of significative mandibular resection, we perform an osteocutaneous peroneal free flap.
Special care is given for the flap in-setting: we suture the flap more caudally than usual under the tongue base (Fig 1). It creates a neo-posterior pilar. The objective is to produce a light tension and reproduce the function of the palatopharyngeus and palatoglossus muscles (Fig 2).

Discussion
Local F give interesting functional results as they preserve the structures. But they are limited to small defects and cannot be used in irradiated tissues. Regional pediculated F bring healthy tissue with no size limitation, but can be too bulky with the risk of secondary defect or velar insufficiency(1–3). Free F remain the best option for large defects. AB F is the most commonly used thanks to its thinness and flexibility.
We describe a new technique for the in-setting : placing the F lower than usual under the tongue base gives tension effect that helps to ensure the sealing with the nasopharynx.
However, this technique increases the risk of early suture failure. During swallowing, the SP tenses while the tongue base lowers, creating opposite tractions (Fig 3).

Conclusion
This new free-flap in-setting technique restores as close as possible the original anatomy and function of the SP.