Staged repair of secondary cleft palate deformities

Despite improvements in cleft palate surgery, residual oronasal fistulas remain a frustrating problem for plastic and reconstructive surgeons because of a high incidence of failure when scarred and immobile neighboring palatal mucoperiosteum is used for secondary closure. Therefore, my colleagues and I have found it necessary to introduce additional tissue from regional sites to close persistent oronasal fistulas. Although each technique may have its successes, no one method can be consistently depended on to repair large palatal fistulas. Even with regional flaps, dehiscence from a scarred surgical site is quite frequent. However, these flaps may still provide satisfactory coverage with staged reconstruction because they will frequently close a significant percentage of the overall defects, which then may be reused to close the remaining defect.