Modified karapandzic flap with radial forearm free flap to reconstruct a large composite upper lip and palate defect: Case report and anatomic study

Functional reconstruction of a combined upper lip and palatal defect presents surgical challenges that differ from either type of defect in isolation. While useful in obtaining tissue coverage for large defects, free flaps lack the ability to re-establish oral muscular function. Further, local or regional flaps are limited by the amount of adjacent tissue that can be recruited without causing excessive deformity. We present a case of an 81-year-old female with a history of recurrent verrucous carcinoma of the anterior maxillary vestibule. The patient underwent wide local excision, resulting in a large hard palate and alveolar defect combined with a complex upper lip defect. A modified Karapandzic flap with bilateral peri-alar extensions and a fasciocutaneous radial forearm free flap were used to restore oral function and close the palatal defect, respectively. In our case, this combined approach allowed for aesthetic reconstruction of the upper lip and functional closure of a large oral nasal fistula. At one year, the patient demonstrates a healthy palatal flap with closure of the oronasal fistula and a competent oral sphincter.