A two-stage PDS sheet repair technique for extremely wide cleft palates; A review from two UK regional cleft centres.

Abstract

To perform an analysis and provide a technical re--ation for a two-stage repair of extremely wide cleft palate only (CPO) cases, using a sheet of polydiaxonone (PDS) as a scaffold at the first stage. A retrospective review of all patients with CPO (average width 18 mm) undergoing two-stage palate repairs. Patients were selected from 2012-2023 and were followed-up for up to four years. The study was undertaken at two regional centres for cleft care in the UK. Sixteen patients met the inclusion criteria of CPO with an extremely wide defect (palate index >0.8) undergoing two-stage repair. The PDS sheet was used during stage one, as a temporary scaffold to allow bridging of the soft tissues, prior to definitive palate closure using the Sommerlad intravelar veloplasty technique. Primary outcome was fistula rates over a 12-month period, with secondary outcomes included patients requiring subsequent secondary surgery. Fourteen out of 16 patients were syndromic or diagnosed with Pierre-Robin Sequence. Mean cleft width at the hard/soft palate junction was 18.09 mm (15-23 mm, SD 2.3, 95% CI 16.9-19.3), mean palate index of 1.14 (0.83-1.73, SD 0.22, 95% CI 1.02-1.26). At the time of the second stage, the residual defect mean was 3.3 mm (0-7 mm, SD 2.4, 95% CI 1.84-4.74) and mean improvement in cleft width between stages was 14.4 mm (8-19.5 mm, SD 3.3, 95% CI 12.4-16.4). There were no first stage post-operative complications. Two patients developed fistulae (12.5%, 95% CI 2-15). One patient required unplanned secondary speech surgery (6.25%, 95% CI 2-32). A two-stage repair using a PDS sheet at the first stage is very useful for extremely wide cleft palates.