Acellular Dermal Matrix Use in Cleft Palate and Palatal Fistula Repair: A Potential Benefit?

Area of Science:

• Craniofacial surgery
• Regenerative medicine
• Biomaterials in surgery

Background:

• Achieving tension-free closure in cleft palate repair is crucial for speech and preventing fistulas.
• Acellular dermal matrix (ADM) has been explored as an adjunct in complex reconstructive procedures.

Purpose of the Study:

• To review the clinical experience of using ADM as an adjunct in cleft palate and palatal fistula repairs.
• To evaluate the efficacy and safety of ADM in these challenging surgical scenarios.

Main Methods:

• A retrospective review of 35 primary cleft palate repairs and 15 palatal fistula repairs using ADM from October 2009 to December 2013.
• ADM was utilized as an interpositional layer or sandwiched graft between palatal flaps.
• Data collected included patient demographics, defect size, fistula rates, recurrence, and complications like exposure or infection.

Main Results:

• ADM was used in cleft palates (mean size 15 mm) and fistulas, with the two-flap palatoplasty technique being dominant.
• The fistula rate for primary palate repair was 8.5%, with a 20% recurrence rate for fistulas.
• ADM exposure occurred in 6 cases (2 in palatoplasty, 4 in fistula repair), leading to extrusion in 2 fistula cases.

Conclusions:

• ADM appears to be a safe and useful adjunct for reducing fistula rates in wide, high-tension cleft palate repairs.
• Its application in challenging palatal fistula closures, especially with compromised tissues, showed less favorable outcomes.
• Further study is needed to strongly recommend routine ADM use in all cleft palate surgeries.