Effect of collagen matrix on postoperative palatal fistula in cleft palate repair

Abstract

Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.

Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result

“…experience-based outcome study revealed a rate of velopharyngeal insufficiency as low as 5.5 percent. 15 Future well-designed studies could also draw conclusive answers regarding the prophylactic purpose of split buccal fat flaps compared with other approaches using autogenous tissues or synthetic biomaterials, such as buccal myomucosal flap, autologous platelet-rich plasma, hemostatic gelatin sponge, collagen membrane, and acellular dermal matrix 5,[21][22][23] for prevention of postoperative palatal fistula and scar contraction.…”

Use of a buccinator myomucosal flap and bilateral pedicled buccal fat pad transfer in wide palatal fistula repair: a case report

“…Palatal fistula is a challenging complication following cleft palate repair [ 2 - 4 ]. Reparative surgery is complex because of inevitable scarring, altered vascularity, and persistent tension after primary palatoplasty [ 5 - 7 ]. However, watertight, tension-free closure of the palate fistula remains the primary treatment of choice, especially for wide fistulas [ 2 ].…”

Frequency and Predictors of Fistulae Occurrence after One Stage Repair with Radical Muscle Dissection for Complete Cleft Palate

“…The frequency of postoperative fistula formation varies depending on the surgical technique used, however typically falls around 2.4 to 35%. 20 Repair under tension is the main trigger of oronasal fistula (ONF) development, and the accessible tissue to repair the palate appears to be insufficient. The risk of developing the ONF is higher in these instances, but it could be avoided in the hands of a skilled practitioner.…”

“…Some studies reported absence of fistula development after cleft palate repair that supports our results. 19,20 This could be linked to the exclusion of patients with very wide palatal clefts and smaller number of the study group. Some studies reported that fistula rate was higher for the more sever degree of clefting.…”