Background One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a 'Third layer' of tissue to enhance smooth

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... and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of " dermis and fat (dermis-fat) graft " to serve as the third protective, supportive and enhancive layer. Aim of the study: To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula. PATIENT AND METHOD The study included 22 patients ( 13 males, 9 females ), ranging in the ages between 2 to 40 years (13 males versus 9 females). The fistula size varies from 4 mm to 25 mm in diameter. Timing of fistula repair ranged between 6 months up to more than 4 years, Fistula assessment was done focusing on size, site, number and shape. Then assessment of surrounding tissue viability and pliability Results, operated upon, having 30 oro-nasal, We used minimal thickness of the graft ( 4-6 mm ) in 23 fistulae, and 7-8 mm thick graft in 7 ones. 24 cases was having full healing while in 2 fistulae partial wound dehiscence occurred. In another 2 fistulae there was obliteration of the buccal sulcus. While partial graft exposure in 2 other fistulae. We experienced no hematoma, or infection or airway obstruction. conclusion Using of interpositional dermis-fat graft had shown to have promising result in closure of oro-nasal fistula that followed cleft palate surgery. It provided durable, stable, and flexible coverage with minimal donor site morbidity. It can be used for fistula of less than 1.5 cm of various locations.