PK UPPP flap.

Plasma knife (PK) assisted UPPP is a modification of the procedure original described by Fujita for snoring. Plasma knife is used for tonsillectomy, hemostasis and to reduce scar contracture lowering incidence of dehiscence (1%) as a result of the reduced thermal injury. Cold knife resection of uvula is limited to the anterior mucosa and any submucosal; preserving the muscularis uvulae and posterior mucosa. A corresponding triangular area of palatal mucosa is removed for reattachment of the uvula. The incision then expands laterally with a V cut into the palatoglossus fold and a horizontal cut across the top of the palatopharyngeous fold creating a sail shaped flap which is rotated laterally into the V cut covering the tonsillar fossa. All mucosa edges are approximated with 2.0 chromic sutures. The rotation flaps widen the pharynx and shifts the vector forces of scar contracture superiorly and laterally preventing pharyngeal stenosis. Preserving the uvula and soft palate decreases the risk of nasopharyngeal insufficiency or regurgitation.