Repair of an untreated cleft palate in an adult using a prefabricated radial forearm flap.

The untreated isolated cleft of the palate in an adult is rarely encountered today. It can also be difficult to close using conventional techniques because of the disparity between the extremely wide cleft and the paucity of available local tissues. One possible solution is a thin radial forearm free flap. If used as a bilaminar flap prefabricated by placement of a skin graft on its fascial undersurface at an initial stage, both the requisite nasal lining and oral mucosa can simultaneously be introduced to close the palate. This maneuver may reduce the potential for late flap contracture and avoids cumbersome methods for immobilizing a skin graft if this were attempted after flap transfer.