A team of surgeons from Lviv and the USA successfully carried out a remarkable surgery to reconstruct the palate using a unique method – a radial forearm flap was utilized to close the defect.
This surgical procedure was the first of its kind in Ukraine, as reported by the medical institution "Okhmatdyt" in Lviv.
The operation was performed on an 18-year-old patient who had previously undergone 11 unsuccessful surgeries to correct the palate defect, each worsening his condition.
As he approached adulthood, the young man fell into depression and no longer believed that help was possible. He faced difficulties with eating, as food would enter his nose, and he struggled with speech, leading him to avoid communication.
"The issue was that after so many surgeries, a significant defect remained in the palate that could not be stitched together. An innovative solution was needed – transplantation of his own tissues.
For such cases, not just any skin with a vascular pedicle would do; a radial forearm flap was necessary. Thus, the surgical team decided to employ this unique method that had never been used in Ukraine before," the doctors explained.
Jaw and facial surgeon Roman Ohanovsky noted that they applied the technique of free tissue transfer in this case. This method is typically employed to reconstruct large defects resulting from gunshot wounds in military patients and after oncological surgeries. Given the patient's similar defect, this technique proved to be the most effective.
The patient was consulted by leading American head and neck surgeons prior to the operation. The plastic and reconstructive surgeon David Lowe, who was well aware of the boy's situation, examined him and together with the team devised a plan for the complex intervention, implementing Dr. Lowe's idea of tissue transplantation.
"We analyzed all possible surgical treatment methods for this pathology, and based on David Lowe's recommendation, we chose the free transfer of the radial flap from the forearm on a vascular pedicle. To ensure the best outcome, we utilized a comprehensive approach – prior to the operation, an orthodontist worked with the patient, and the tissues were prepared for surgery," said jaw and facial surgeon Kristina Pohanichna.
The surgeons employed the radial forearm flap technique, taking the artery, vein, and skin flap from the forearm and transplanting it to the palate defect area to the facial artery. The surgery lasted 7 hours and was successful.
"The first three days post-operation were critical. It was essential to monitor the flap's viability and ensure the anastomosis was functioning. We monitored the pulsation of the vessels in the flap and the anastomosis.
This indicates that everything went well; the tissues are functioning in their new location, the palate is receiving sufficient blood supply, and the postoperative wound is healing properly," noted vascular surgeon Julia Khomin.
The doctors successfully eliminated the palate defect, allowing the young man to eat properly and improving his speech. Additionally, a hospital psychologist is working with him to help combat his depression.
