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"Flip-over flap" in two-stage cleft palate repair
Maurice Y Mommaerts1, Karsten Kh Gundlach2, Ana Tache1
1European Face Centre (Head: Prof. Dr. mult. Maurice Y. Mommaerts), Cleft & Craniofacial Team, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
Summary
This study evaluated a two-stage cleft palate repair technique using a triangular hinge ("flip-over") flap. This method may help prevent palatal fistulae, particularly at the hard and soft palate junction.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Palatal fistulae are a common complication following cleft palate repair.
- Two-stage repair techniques aim to minimize such complications.
- The triangular hinge (flip-over) flap is a reconstructive tool with potential benefits.
Purpose of the Study:
- To evaluate a two-stage cleft palate repair concept.
- To assess the efficacy of a triangular hinge (flip-over) flap in preventing palatal fistulae.
- To compare outcomes with existing literature data.
Main Methods:
- Prospective registry data from 1991 onwards.
- Two-stage repair: Furlow soft palate repair (1 year) and hard palate closure (4 years).
- Utilized paring of edges, Veau flaps, and the triangular hinge flap for posterior nasal layer closure.
Main Results:
- The palatal fistula rate for Veau II-IV types was 4.3%.
- Overall fistula rate was 2.9%, lower than meta-analyses averages (4.9-8.6%).
- Fistula rates decreased to zero after 2010, potentially due to flap technique, collagen membranes, and surgical experience.
Conclusions:
- The triangular hinge (flip-over) flap may be effective in preventing fistulae.
- This technique shows promise in two-stage cleft palate repair.
- Further research may explore combined techniques for optimal outcomes.