The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited

Background: Although a host of local soft tissue flaps have been described for the reconstruction of postoperative palatal defects, tissue-borne palatal obturators remain the most common form of rehabilitation of these defects. The palatal island flap, first applied to the reconstruction of the retromolar trigone and palatal defects, was first described by Gullane and Arena in 1977. This single-staged mucoperiosteal flap offers a reliable source of regional vascularized soft tissue that obviates the need for prosthetic palatal rehabilitation. Objective: To describe a series of 5 cases in which the palatal island flap was used as a primary palatal or retromolar reconstruction. Methods: We have retrospectively reviewed 5 consecutive cases between March 1998 and August 1999 wherein palatal island flaps were used for the primary reconstruction of postablative palatal defects. Each case was reviewed for primary pathologic findings, postoperative wound complications, postoperative speech and swallowing, and donor site morbidity. Selection of this reconstructive technique was based on the size and location of the defect and the assessment by the surgeon that the arc of rotation and amount of residual palatal mucosa were appropriate. Results: Six local palatal island flaps were performed on 5 patients who had not undergone irradiation (1 patient underwent bilateral flaps). The primary pathologic findings included T1 NO squamous cell carcinoma, T4 NO squamous cell carcinoma, T2 NO low-grade mucoepidermoid carcinoma, pigmented neurofibroma, and T2 NO low-grade clear cell carcinoma. All of the lesions were located on the hard or soft palate or the retromolar trigone, and the average defect size was 7.2 cm². All 5 patients began an oral diet between postoperative days 1 and 5 (mean, 2 days), and all patients were discharged home without postoperative donor site or recipient site complications between days 1 and 6 (mean, 3 days). Donor site reepithelialization was complete by 4 weeks in all 5 patients. Conclusions: The palatal island flap offers a reliable method of primary reconstruction for limited lesions of the retromolar trigone and hard and soft palate. The mucoperiosteal tissue associated with this flap is ideal for partitioning the oral and nasal cavities and obviates the need for prosthetic palatal obturation.