Department of Otolaryngology
University of Arkansas for Medical Sciences
4301 W Markham
Little Rock, AR 72205
SECOND ONLY to concerns about velopharyngeal insufficiency is the cleft palate surgeon's fear of postoperative fistula: the failure to construct a tissue barrier between oral and nasal cavities. Drs Clark, Safford, and Israel have contributed another tool in efforts to avoid and/or correct this troubling complication of palatoplasty.
After a cogent discussion of the pathophysiology of fistulas and attempts at closure, the authors present 7 consecutive 2-flap palatoplasties for "wide" cleft palates (>15 mm at the posterior edge of the hard palate) using a decellularized dermal allograft (AlloDerm). They adopted this method after its success in closing a postoperative fistula. During short follow-up periods (2-13 months), there were no fistulas even though 2 patients experienced oral mucosal dehiscence exposing the graft. There was no untoward local reaction (rejection, infection, scarring, or contracture). The authors concluded that "Decellularized allograft dermal matrix was used successfully to close wide defects involving the hard and soft palate."
Seibert RW. Comments on Decellularized Dermal Allograft. Arch Facial Plast Surg. 2003;5(1):45. doi: