Chandrappa Ashok B, Batth Ritu S, Vasudevan Srikanth, Yellambalase Anantheswar N R, Kumar Pradeep N, Reddy Sudarshan, Seles J Nidya
Department of Plastic and Reconstructive surgery, Manipal Hospital, Bangalore, Karnataka, India.
Department of Speech and Language Pathology, Manipal Hospital, Bangalore, Karnataka, India.
Craniomaxillofac Trauma Reconstr. 2020 Mar;13(1):71-77. doi: 10.1177/1943387520904879. Epub 2020 Mar 16.
Palatal defects are encountered following tumor extirpation, trauma, or congenitally. Among the known alternatives, radial artery free forearm flap (RAFF) is a versatile flap that confers good results in head and neck reconstruction, but donor-site morbidity has been an issue of discontent among the plastic surgeons. This limitation needs to be studied further and addressed considering the unmatched quality of this tissue.
This study aims to weigh the impact of the functional edge of this flap against the unpopular donor-site morbidity on a group of patients.
This is a retrospective analysis of recuperation of palatal function and patient concerns with the donor-site function and cosmesis on 7 consecutive patients with small-to-moderate palatal defects reconstructed with RAFF.
Postoperative recovery of speech, palatal movement, and restoration of oromaxillary interface was assessed using objective tests, such as speech intelligibility testing and articulation studies. Simultaneously, subjective donor-site function and cosmesis were assessed using Patient Scar Assessment Scale (PSAS), Upper Extremity Functional Index (UEFI), and donor limb sensory testing.
Mean PSAS score was 8.28/60, and UEFI score reported was 77/80, which reflect high patient satisfaction with the donor site. Nasoendoscopy shows remarkable restoration of palate anatomy. Intelligibility testing depicts near-normal speech understandability, whereas articulation studies revealed distortions post-palatal reconstruction with RAFF. Radial artery free forearm flap should be considered as the forerunner of reconstruction in palatal defects involving less than 50%.
腭部缺损可因肿瘤切除、外伤或先天性因素导致。在已知的替代方案中，桡动脉游离前臂皮瓣（RAFF）是一种多功能皮瓣，在头颈部重建中效果良好，但供区并发症一直是整形外科医生不满的问题。考虑到该组织质量无可比拟，这一局限性需要进一步研究并加以解决。
本研究旨在权衡该皮瓣功能优势与其在一组患者中不受欢迎的供区并发症的影响。
这是一项对7例连续使用RAFF修复中小腭部缺损患者的腭部功能恢复情况以及患者对供区功能和美观问题的回顾性分析。
使用语音清晰度测试和发音研究等客观测试评估术后语音、腭部运动以及口颌界面的恢复情况。同时，使用患者瘢痕评估量表（PSAS）、上肢功能指数（UEFI）和供区肢体感觉测试评估供区主观功能和美观情况。
PSAS平均得分为8.28/60，UEFI报告得分为77/80，这反映出患者对供区的高度满意度。鼻内镜检查显示腭部解剖结构显著恢复。清晰度测试显示语音可懂度接近正常，而发音研究显示RAFF修复腭部后存在发音扭曲。桡动脉游离前臂皮瓣应被视为修复小于50%腭部缺损的首选方法。
