The repair of wide cleft palates and secondary palatal fistulas remains a challenge for pediatric plastic surgeons. To reduce the incidence of fistulization, use of acellular dermal matrix to facilitate closure has been reported in the literature. A review of the literature was performed to assess whether sufficient evidence exists to recommend the routine use of acellular dermal matrix for either primary palatoplasty or secondary palatal fistula repair.
A literature search for the period between 1970 and 2011 was performed. All articles with clinical application of acellular dermal matrix in primary palatoplasty or palatal fistula repair were included. Data were analyzed using weighted averages to compare fistula rates between repairs performed with and without acellular dermal matrix (historical controls) for each repair type (primary versus secondary fistula repairs).
Four studies examined the use of acellular dermal matrix in primary palatoplasty (n = 92) with a mean cleft width of 14.2 mm. The overall fistula rate was 5.4 percent compared with 10.6 percent in the non–acellular dermal matrix historical control group. Five studies used acellular dermal matrix in palatal fistula repair (n = 74). The overall recurrent fistula rate was 8.1 percent compared with 12.9 percent in the historical control group.
Based on the available data, the results imply that acellular dermal matrix may have a potential benefit in reducing fistula formation/persistence in palate surgery. However, the authors did not find sufficient prospective randomized (level II or better) evidence to recommend the routine use of acellular dermal matrix for cleft palate repair.
Montreal, Quebec, Canada
From the Division of Plastic and Reconstructive Surgery, McGill University Health Center, H. B. Williams Craniofacial and Cleft Surgery Unit, Montreal Children's Hospital.
Received for publication January 25, 2012; accepted February 2, 2012.
Disclosure: The authors have no financial conflict of interest in the publication of this article. No funds were received for this article.
Mirko S. Glardino, M.D., M.Sc.; H.B. Williams Craniofacial and Cleft Surgery Unit, Montreal Children's Hospital, Suite C11.35, 2300 Tupper Street, Montreal, Quebec, Canada, H3H 1P3, firstname.lastname@example.org