Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations.

The aim of this study was to describe the surgical and functional complications following superiorly based posterior pharyngeal wall (SBPP) flap surgery. Records of 130 patients with velopharyngeal insufficiency (VPI) who had undergone SBPP flap surgery as a secondary procedure to reduce nasal resonance in speech were reviewed. Complications were defined as the incidence of revisional surgery required to obtain a more satisfactory result. 20 patients (15%) required revisional surgery. In 4 patients (3%) early revisional surgery was indicated to treat surgical complications (1 postoperative bleeding, 3 flap dehiscences). In 16 patients (12%) late revisional surgery was indicated to achieve a better functional result with regard to nasal resonance in speech. The low incidence of surgical complications indicates that SBPP flap surgery is a safe procedure. After SBPP flap surgery, a satisfactory functional result with respect to nasal resonance was obtained in 88% of patients. This result was improved after revisional surgery. The hypothesis that the patients of an experienced surgeon have fewer complications and better functional results than those of a less experienced one was tested. The individual skill of the surgeon rather than their experience led to a better functional result.