Reconstruction of Recalcitrant Hard Palate Fistulas With Free Medial Femoral Condyle Flap

BACKGROUND: Recurrent hard palate fistulas remain a challenging problem in cleft palate surgery, particularly after multiple failed local and regional flap attempts. Although free flaps provide reliable closure, excessive intraoral bulk and donor-site morbidity may compromise functional outcomes. The free medial femoral condyle (fMFC) flap offers thin, well-vascularized tissue with the option of vascularized bone, closely matching native palatal anatomy. METHODS: This retrospective study included cleft palate patients who underwent reconstruction of recalcitrant hard palate fistulas using the fMFC flap between 2015 and 2025. Patient demographics, fistula characteristics, previous repair attempts, complications, and follow-up outcomes were analyzed. Nasal lining was reconstructed using bilateral hinge flaps prior to fMFC inset. RESULTS: Seven patients (mean age 19.5 y) were included, all with a history of multiple failed fistula repairs (mean 2.2 previous surgeries). Six fistulas were located in the anterior hard palate and one in the mid-palate. The mean fistula size was 1.95 cm², and the average follow-up period was 27 months. Complete closure was achieved in all but one patient, who developed partial bone exposure that healed with secondary granulation. No donor-site morbidity was observed. CONCLUSION: The fMFC flap is a reliable and effective option for reconstruction of small, recalcitrant hard palate fistulas. It provides excellent tissue compatibility, minimal intraoral bulk, and low donor-site morbidity, making it a valuable alternative when local and regional flaps are unsuitable.