J Korean Assoc Oral Maxillofac Surg.  2016 Apr;42(2):77-83. 10.5125/jkaoms.2016.42.2.77.

Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study

• Richardson S
• Hoyt JS
• Khosla RK
• Khandeparker RVS
• Sukhadia V
• Agni N

• KMID: 2351729
• DOI: http://doi.org/10.5125/jkaoms.2016.42.2.77

Abstract

OBJECTIVES
To evaluate the effectiveness of regenerative tissue matrix (Alloderm) as an oral layer for difficult anterior palatal fistula closure.
MATERIALS AND METHODS
The authors have tested the feasibility of a novel surgical technique of adding a regenerative tissue matrix (Alloderm) as an oral layer for closure of recalcitrant large anterior palatal fistulae and report the outcome of the first 12 patients in this pilot study. Patients with recurrent large fistula who otherwise would require either a local pedicled flap, free flap, or an obturator were treated with this technique and followed up for at least 6 months to monitor the progress of healing.
RESULTS
Of the 12 patients, 8 patients (66.7%) had complete closure of the fistula, and 2 patients (16.7%) showed reduction in size of the fistula to the extent that symptoms were eliminated, for an overall success rate of 83.3% (10/12 patients). Premature graft loss and recurrence of the fistula were noted in 2 patients (16.7%).
CONCLUSION
Alloderm provided an adequate barrier allowing healing to occur unimpeded and allowed closure of the palatal fistula. In our experience, this new technique using regenerative tissue matrix as an adjunct to the oral layer in large anterior palatal fistula has an advantage compared to other more invasive complex procedures and has been shown to provide satisfactory results.

Keyword

Alloderm; Fistula repair; Cleft palate; Regenerative tissue matrix; Oral layer

MeSH Terms

Cleft Palate
Collagen
Fistula*
Free Tissue Flaps
Humans
Pilot Projects*
Recurrence
Surgical Flaps
Transplants

Figure

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  Fig. 1 Intraoperative photograph shows the placement of the Alloderm (LifeCell Corporation) graft as the oral layer.

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  Fig. 2 Schematic representation of the technique used for anterior palatal fistula closure and placement of Alloderm (LifeCell Corporation) as an oral layer. A. Preoperative illustration shows the anterior palatal fistula. B. Planning of turn down flaps around the fistula. C. Closure of the nasal layer in a watertight manner. D. Placement of Alloderm as an oral layer sutured to the palatal mucoperisoteum.

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  Fig. 3 Clinical photographs of anterior palatal fistula closure in patient 1. A. Preoperative. B. Intraoperative with Alloderm (LifeCell Corporation) in situ. C. Postoperative 6 months with complete closure of the fistula.

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  Fig. 4 Clinical photographs of anterior palatal fistula closure in patient 2. A. Preoperative. B. Intraoperative with Alloderm (LifeCell Corporation) in situ. C. Postoperative 6 months with complete closure of the fistula.

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  Fig. 5 Clinical photographs of anterior palatal fistula closure in patient 3. A. Preoperative. B. Intraoperative with Alloderm (LifeCell Corporation) in situ. C. Postoperative 6 months with complete closure of the fistula.

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