Low Fistula Rate in Palatal Clefts Closed with the Furlow Technique Using Decellularized Dermis

Abstract

A low fistula rate was obtained in Furlow technique palatal cleft repairs using decellularized dermis when compared with historical controls. Decellularized dermis may provide an additional barrier to wound breakdown in the postoperative period and may improve fistula rate.

Development of an Acellular Bioengineered Matrix with a Dominant Vascular Pedicle

“…The fact that the extracellular matrix can withstand the decellularization process and retain its integrity such that channels remain where the vessels had been previously is made evident by the clinical efficacy of Alloderm, the widely-used, commercially available dermal replacement product that is derived from decellularized human dermis (and its porcine homologue, Strattice). In addition to its primary use as a dermal replacement, it is also commonly used in hernia [13] and cleft palate [14] repairs, as well as an adjunct to esophageal anastomosis [15] and breast reconstruction [16]. The most significant limitation of Alloderm is that while the microvascular architecture remains largely intact, it lacks a macrovasculature that could be accessed as a means for immediate perfusion of the entire construct.…”

An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure

“…In the literature, the fistula rate following Furlow palatoplasty ranged from 0.76% to 23.3%. 1,10,[12][13][14][15][16][17][18][19][20] Although the fistula rate for Furlow palatoplasty gradually reduced, its occurrence was higher than that of the von Langenbeck procedures. Brothers et al, 21 reported a fistula rate of 0% in 10 patients with Wardill-Kilner palatoplasties versus 5% in 21 patients with Furlow repairs.…”

Cleft Lip and Palate

“…20 One concern raised with this technique is the increased rates of oronasal fistulas. 76 Only anecdotal evidence is available for the use of acellular dermis placed between the oral and nasal flaps to decrease in fistula rates 77,78 (Level IV evidence).…”