DOI QR코드

DOI QR Code

Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study

  • Richardson, Sunil (Richardsons Dental and Craniofacial Hospital) ;
  • Hoyt, James S. (Private Practitioner) ;
  • Khosla, Rohit K. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University) ;
  • Khandeparker, Rakshit Vijay Sinai (Richardsons Dental and Craniofacial Hospital) ;
  • Sukhadia, Vihang Y. (Sukriti Hospital) ;
  • Agni, Nisheet (Godrej Memorial Hospital)
  • 투고 : 2015.10.21
  • 심사 : 2015.12.10
  • 발행 : 2016.04.30

초록

Objectives: To evaluate the effectiveness of regenerative tissue matrix (Alloderm) as an oral layer for difficult anterior palatal fistula closure. Materials and Methods: The authors have tested the feasibility of a novel surgical technique of adding a regenerative tissue matrix (Alloderm) as an oral layer for closure of recalcitrant large anterior palatal fistulae and report the outcome of the first 12 patients in this pilot study. Patients with recurrent large fistula who otherwise would require either a local pedicled flap, free flap, or an obturator were treated with this technique and followed up for at least 6 months to monitor the progress of healing. Results: Of the 12 patients, 8 patients (66.7%) had complete closure of the fistula, and 2 patients (16.7%) showed reduction in size of the fistula to the extent that symptoms were eliminated, for an overall success rate of 83.3% (10/12 patients). Premature graft loss and recurrence of the fistula were noted in 2 patients (16.7%). Conclusion: Alloderm provided an adequate barrier allowing healing to occur unimpeded and allowed closure of the palatal fistula. In our experience, this new technique using regenerative tissue matrix as an adjunct to the oral layer in large anterior palatal fistula has an advantage compared to other more invasive complex procedures and has been shown to provide satisfactory results.

키워드

참고문헌

  1. Amaratunga NA. Occurrence of oronasal fistulas in operated cleft palate patients. J Oral Maxillofac Surg 1988;46:834-8. https://doi.org/10.1016/0278-2391(88)90044-4
  2. Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg 1991;87:1041-7. https://doi.org/10.1097/00006534-199106000-00005
  3. Muzaffar AR, Byrd HS, Rohrich RJ, Johns DF, LeBlanc D, Beran SJ, et al. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair. Plast Reconstr Surg 2001;108:1515-8. https://doi.org/10.1097/00006534-200111000-00011
  4. Abyholm FE, Borchgrevink HH, Eskeland G. Palatal fistulae following cleft palate surgery. Scand J Plast Reconstr Surg 1979;13: 295-300. https://doi.org/10.3109/02844317909013073
  5. Rintala AE. Surgical closure of palatal fistulae: follow-up of 84 personally treated cases. Scand J Plast Reconstr Surg 1980;14:235-8. https://doi.org/10.3109/02844318009106716
  6. Denny AD, Amm CA. Surgical technique for the correction of postpalatoplasty fistulae of the hard palate. Plast Reconstr Surg 2005;115:383-7. https://doi.org/10.1097/01.PRS.0000148650.32055.01
  7. Jeffery SL, Boorman JG, Dive DC. Use of cartilage grafts for closure of cleft palate fistulae. Br J Plast Surg 2000;53:551-4. https://doi.org/10.1054/bjps.2000.3411
  8. Wilhelmi BJ, Appelt EA, Hill L, Blackwell SJ. Palatal fistulas: rare with the two-flap palatoplasty repair. Plast Reconstr Surg 2001;107:315-8. https://doi.org/10.1097/00006534-200102000-00002
  9. Schwabegger AH, Hubli E, Rieger M, Gassner R, Schmidt A, Ninkovic M. Role of free-tissue transfer in the treatment of recalcitrant palatal fistulae among patients with cleft palates. Plast Reconstr Surg 2004;113:1131-9. https://doi.org/10.1097/01.PRS.0000110370.67325.ED
  10. LifeCell website [Internet]. Bridgewater (NJ): LifeCell Corporation [cited 2011 Aug 10]. Available from: http://www.lifecell.com.
  11. Butler CE, Prieto VG. Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction. Plast Reconstr Surg 2004;114:464-73. https://doi.org/10.1097/01.PRS.0000132670.81794.7E
  12. Baxter RA. Intracapsular allogenic dermal grafts for breast implant-related problems. Plast Reconstr Surg 2003;112:1692-6. https://doi.org/10.1097/01.PRS.0000086365.25453.C3
  13. Clark JM, Saffold SH, Israel JM. Decellularized dermal grafting in cleft palate repair. Arch Facial Plast Surg 2003;5:40-4. https://doi.org/10.1001/archfaci.5.1.40
  14. Cole P, Horn TW, Thaller S. The use of decellularized dermal grafting (AlloDerm) in persistent oro-nasal fistulas after tertiary cleft palate repair. J Craniofac Surg 2006;17:636-41. https://doi.org/10.1097/00001665-200607000-00005
  15. Schultz RC. Management and timing of cleft palate fistula repair. Plast Reconstr Surg 1986;78:739-47. https://doi.org/10.1097/00006534-198678060-00004
  16. Sclafani AP, Romo T 3rd, Jacono AA, McCormick S, Cocker R, Parker A. Evaluation of acellular dermal graft in sheet (AlloDerm) and injectable (micronized AlloDerm) forms for soft tissue augmentation. Clinical observations and histological analysis. Arch Facial Plast Surg 2000;2:130-6. https://doi.org/10.1001/archfaci.2.2.130
  17. Rhee PH, Friedman CD, Ridge JA, Kusiak J. The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts. Arch Otolaryngol Head Neck Surg 1998;124:1201-4. https://doi.org/10.1001/archotol.124.11.1201
  18. Helling ER, Dev VR, Garza J, Barone C, Nelluri P, Wang PT. Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis. Plast Reconstr Surg 2006;117:2361-5. https://doi.org/10.1097/01.prs.0000218788.44591.f0
  19. Kirschner RE, Cabiling DS, Slemp AE, Siddiqi F, LaRossa DD, Losee JE. Repair of oronasal fistulae with acellular dermal matrices. Plast Reconstr Surg 2006;118:1431-40. https://doi.org/10.1097/01.prs.0000239612.35581.c3
  20. Steele MH, Seagle MB. Palatal fistula repair using acellular dermal matrix: the University of Florida experience. Ann Plast Surg 2006;56:50-3. https://doi.org/10.1097/01.sap.0000185469.80256.9e

피인용 문헌

  1. Repair of Primary Cleft Palate and Oronasal Fistula With Acellular Dermal Matrix: A Systematic Review and Surgeon Survey vol.56, pp.2, 2016, https://doi.org/10.1177/1055665618774028
  2. A Toolbox of Surgical Techniques for Palatal Fistula Repair vol.58, pp.2, 2016, https://doi.org/10.1177/1055665620949321