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Do babies require arm splints after cleft palate repair?
V Jigjinni1, T Kangesu, B C Sommerlad
1North East Thames Regional Plastic Surgery Unit, St Andrew's Hospital, Billericay, Essex, UK.
Insights
Arm splints are commonly used after cleft palate repair but a study found they do not prevent oronasal fistulae. This research suggests abandoning their routine use in postoperative care for children.
Area of Science:
- Pediatric Plastic Surgery
- Craniofacial Surgery
- Surgical Outcomes Research
Background:
- Arm restraints are traditionally used post-cleft palate surgery to prevent disruption of the surgical repair.
- A UK survey indicated widespread use of arm splints among consultant plastic surgeons.
- The efficacy of arm splints in preventing complications after cleft palate repair has been questioned.
Purpose of the Study:
- To evaluate the effectiveness of postoperative arm splints in reducing the incidence of oronasal fistulae following primary cleft palate repair.
- To provide evidence-based guidance on the use of arm restraints in pediatric cleft surgery.
Main Methods:
- A prospective randomized trial involving 46 children undergoing primary cleft palate repair.
- Children were randomly assigned to receive either postoperative arm splints or no splints.
- The incidence of oronasal fistulae was compared between the two groups.
Main Results:
- Arm splints did not significantly decrease the incidence of oronasal fistulae.
- Oronasal fistulae developed in 6 of 21 children (28.6%) who used arm splints.
- Oronasal fistulae developed in 5 of 25 children (20%) who did not use arm splints.
Conclusions:
- Postoperative arm splints are not effective in preventing oronasal fistulae after primary cleft palate repair.
- The routine use of arm splints following cleft palate repair should be abandoned.
- Clinical practice should be updated based on this evidence to improve patient outcomes.
Abstract:
Traditionally, arm restraints are used in children after cleft surgery to prevent traumatic disruption of the repair. A questionnaire amongst consultant plastic surgeons in the UK that restraints are in common use. However, a prospective randomised trial of 46 children having primary cleft palate repair showed that arm splints did not decrease the incidence of oronasal fistulae. Six of 21 children who had arm splints in the postoperative period and 5 of 25 who did not have splints developed an oronasal fistula. We have therefore abandoned the use of arm splints after cleft palate repair.