Low fistula rate in palatal clefts closed with the furlow technique using decellularized dermis

BACKGROUND: Despite the advances in cleft palate closure over the past 20 years, postoperative fistulas are still a significant problem. Fistula rates average 10 to 23 percent, and it has been suggested that wide clefts have a higher rate of fistula formation. METHODS: In an attempt to improve closure rates, the authors placed decellularized dermal graft within the closure of 31 consecutive palatal cleft closures using the Furlow technique, with one attending surgeon. A retrospective review of this series of patients was analyzed for cleft width, Veau type, and rate of healing. RESULTS: Average cleft width was 12.2 mm (range, 8 to 15 mm). There were one Veau type I, five Veau type II, 20 Veau type III, and six Veau type IV patients. The average age at time of palate repair was 11.75 months (range, 8 to 28 months). One patient (Veau type IV, 15-mm width) developed fistula (3.2 percent fistula rate overall). There was no evidence of rejection, scarring, or impaired palatal motion by examination. CONCLUSIONS: A low fistula rate was obtained in Furlow technique palatal cleft repairs using decellularized dermis when compared with historical controls. Decellularized dermis may provide an additional barrier to wound breakdown in the postoperative period and may improve fistula rate.