Repair of oronasal fistulae with acellular dermal matrices.
BACKGROUND
The authors examined the efficacy of a novel technique for oronasal fistula repair using acellular dermal matrix grafts. In part I, an animal model was used to demonstrate proof-of-concept; in part II, the method was applied to oronasal fistula repair in the clinical setting.


METHODS
In part I, oronasal fistulas were created in Yorkshire piglets (n = 6) and allowed to mature for 2 weeks. In three animals, acellular dermal grafts were interposed between the oral and nasal mucosa traversing the palatal fistulas. Mucosal edges were not closed. Three weeks postoperatively, the palates were examined histologically. The fistulas of control piglets (n = 3) remained unrepaired and were examined 5 weeks after their creation. In part II, acellular dermal grafts were interposed between the oral and nasal mucosa in nine consecutive patients undergoing oronasal fistula repair. Complete closure of the oral and nasal mucosa was achieved in two patients. In the remainder, nasal closure was affected by interposition of the dermal matrices beneath a complete oral mucosal closure.


RESULTS
All animals that underwent fistula repair demonstrated successful healing with revascularization, complete reepithelialization, and cellular infiltration into the grafts. All control fistulas remained patent. Successful fistula closure was observed in all patients. In two patients, early oral mucosal dehiscence and exposure of the dermal graft was followed by complete healing.


CONCLUSIONS
This study demonstrates successful closure of palatal fistulas in an animal model and in cleft palate patients using interposition grafts of acellular dermis. This novel method offers promise as a simple and effective technique for tension-free closure of oronasal fistulas.
Kirschner
Richard E
RE
Philadelphia and Pittsburgh, Pa.; and Salt Lake City, Utah From the Department of Surgery and Division of Plastic Surgery, Children's Hospital of Philadelphia; Division of Plastic/Reconstructive Surgery, University of Utah Health Sciences Center; and Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh.
Cabiling
David S
DS
Slemp
Alison E
AE
Siddiqi
Faizi
F
LaRossa
Don D
DD
Losee
Joseph E
JE
D000328:Adult; D000818:Animals; D002972:Cleft Palate / Q000473:pathology / Q000601:surgery*; D020405:Dermis / Q000637:transplantation*; D004195:Disease Models, Animal; D006801:Humans; D009668:Nose Diseases / Q000601:surgery; D016155:Oral Fistula / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D013552:Swine; D016896:Treatment Outcome