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J. Madison Clark, MD; Scott H. Saffold, MD; Jeffrey M. Israel, MD

Arch Facial Plast Surg. 2003;5:40-44.

Objective  To assess the efficacy of decellularized dermal grafting used as an adjunct to the performance of primary repair of wide cleft palates.

Design  Retrospective review.

Setting  Tertiary referral center for large managed care organization.

Methods  Seven consecutive patients with clefts of the hard and soft palates wider than 15 mm as measured at the posterior edge of the hard palate. Palates were repaired in the standard 2-flap approach with intravelar veloplasty. The decellularized dermal graft (AlloDerm) was applied immediately deep to the oral mucosal closure. Patients were followed up with serial postoperative examination. Palates were assessed for dehiscence, fistula, infection, rejection, scarring, and contracture.

Results  There were no fistulas. In 2 patients, the oral mucosa dehisced, exposing the dermal graft. In 2 other cases, nasal mucosal tears were inadvertently created during closure of the nasal layer. In all cases, the decellularized dermal graft mucosalized and, by clinical examination, became incorporated into the wound. There were no cases of local inflammation or infection. The degree of scarring and contracture was indistinguishable from the adjacent scar.

Conclusions  Decellularized dermal graft is safe and effective for use in primary closure of wide clefts involving the hard and soft palates. Its application to wide clefts otherwise at risk of fistula is justified. Its use in repair of an existing fistula is also promising.

From the Department of Otolaryngology, Head and Neck Surgery, Oregon Health Sciences University, Portland (Drs Clark and Saffold), and Kaiser Permanente Health Care Systems, Clackamas, Ore (Dr Israel).

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