Superior results using the islandized hemipalatal flap in palatoplasty: experience with 500 cases

The double-opposing Z-plasty palatal repair, as reported by Dr. Furlow, is one of the most popular methods of primary cleft palate repair. However, the repair as originally described is difficult to perform on wide palatal clefts. The authors have modified the original repair by altering the hard palatal flap design to allow for better mobilization and improved closure of the cleft.

The authors performed a retrospective review of 500 consecutive children undergoing double-opposing Z-plasty cleft palate repairs with or without islandization of the hemipalate on its vascular pedicle over a 10-year period at Children's Hospital Los Angeles. Children were evaluated based on their age at the time of repair, extent of cleft, and occurrence of postoperative fistulas.

Three hundred thirty-two children underwent pedicle lengthening and 168 children did not. The overall fistula rate in this series was 5.0 percent. When the experience of the five cleft surgeons in this series was combined, patients undergoing pedicle lengthening had significantly lower fistula rates (2.1 percent) than patients undergoing palatoplasty without pedicle lengthening (10.6 percent). Patient gender, age, and extent of clefting did not correlate with the rate of fistula formation in this study. There was only one partial flap loss, early in the authors' series.

The authors' data suggest that a double-opposing Z-plasty palate repair performed with islandization results in lower postoperative fistula rates when compared with repair performed without islandization.