Continuous circular closure in unilateral cleft lip and plate repair in one surgery
Benito K Benitez1, Andrzej Brudnicki2, Zbigniew Surowiec2
1Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland.
Insights
This study shows that single-stage, two-layer continuous closure for unilateral cleft lip and palate (UCLP) results in excellent wound healing without fistulas. The technique also demonstrated a significant reduction in cleft width and a favorable safety profile.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Unilateral cleft lip and palate (UCLP) repair requires precise surgical techniques to ensure optimal outcomes.
- Assessing novel surgical methods for UCLP is crucial for improving patient healing and reducing complications.
Purpose of the Study:
- To evaluate the wound healing and safety of a single-stage, two-layer continuous closure technique in UCLP patients.
- To assess fistula formation, hospital stay, and adverse events associated with this UCLP repair method.
Main Methods:
- A retrospective descriptive cohort study involving 11 UCLP patients who underwent single-stage, two-layer continuous closure.
- Wound healing, fistula formation, hospital stay, and adverse events were assessed at 1, 3, and 6 months post-surgery.
- Cleft width changes after presurgical orthopedics were compared from birth to surgery.
Main Results:
- All 11 patients achieved full primary healing without any fistula formation.
- The median postoperative hospital stay was 5 days, with no adverse events exceeding Grade I.
- A significant reduction in palatal cleft width was observed from birth to surgery (anteriorly and posteriorly).
Conclusions:
- Single-stage, two-layer continuous closure appears to be a safe and effective technique for UCLP repair, promoting good wound healing.
- Further research is warranted to confirm these findings and investigate potential long-term effects, such as maxillary growth inhibition.
Abstract:
The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.
