title: The efficacy of vomer flap for closure of hard palate during primary lip repair.
abstract: OBJECTIVE
  This study presents the institutional experience of the use of vomer flap for early closure of hard palate during unilateral complete cleft-lip repair. The purpose of this study was to determine the survival rate of the vomer flap and to investigate its effect on the subsequent palatoplasty.
  
  
  METHODS
  This retrospective analysis includes 101 non-syndromic patients with complete unilateral cleft lip who received a vomer flap for the closure of the hard palate during cleft-lip repair. Patients were aged 6 months to 28 years (median 1 year). Success rates of the vomer flaps were assessed clinically and through pre-operative photographs taken at the time of subsequent palate repair. Ninety-two patients returned for second-stage palate repair, and 74 patients with adequate post-operative follow-up information were statistically analysed.
  
  
  RESULTS
  Of the 101 patients who were operated with primary lip repair and simultaneous vomer flap, only 54 (52.4%) vomer flaps healed completely. Out of 92 patients who returned for subsequent palatoplasty, 71 (77.2%) were operated with the two-flap technique, and 19 (20.7%) received von Langenbeck repairs. Seven (9.1%) patients had a surgical complication. The failure of previous vomer repair and von Langenbeck surgical technique were identified as factors associated with post-operative complications.
  
  
  CONCLUSIONS
  We conclude that failed vomer flaps increased the risks of complications in the subsequent palate repair. Furthermore, efforts to use von Langenbeck technique rather than the two-flap technique also resulted in increased surgical complications. As a result, we have abandoned the use of the vomer flap with primary lip repair.
authors.affiliation: Operation Smile Guwahati Comprehensive Cleft Care Center, Guwahati, Assam, India. Electronic address: drgaurav82@gmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Deshpande
authors.affiliation: Operation Smile Guwahati Comprehensive Cleft Care Center, Guwahati, Assam, India.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wendby
authors.affiliation: Operation Smile Guwahati Comprehensive Cleft Care Center, Guwahati, Assam, India.
authors.forename: Rasika
authors.initials: R
authors.lastname: Jagtap
authors.affiliation: Operation Smile Guwahati Comprehensive Cleft Care Center, Guwahati, Assam, India; Department of Plastic and Reconstructive Surgery, Skane University Hospital, Jan Waldenstroms Gata 18, 20502, Malmo, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Schönmeyr
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery*; D008297:Male; D008437:Maxilla / Q000254:growth & development; D021362:Palate, Hard / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055172:Vomer / Q000637:transplantation*; D055815:Young Adult
keywords: Early hard palate closure; Fistula; Maxillary growth; Vomer flap