Dermal substitute reinforced single-layer closure of the palatal fistula

Postoperative palatal fistulas are common after surgery to correct a cleft palate. The repair is hindered by palatoplasty-related scar tissue, reduced vascularity, and restricted mobility of flaps. Surgical repair of fistulae is often effective, but recurrence is common. A 3.5-year-old boy presented with anterior palatal fistula. The presence of peri-fistulous scarring prevented two-layered closure. Nasal layer closure was achieved but not the oral layer. The dermal matrix was reinforced in a one-step procedure over the nasal layer and fixed in place using a gel foam. At 6 months, the fistula almost completely healed, with only a pinpoint track remaining that occasionally leaked into the nasal cavity. These results indicate that the application of dermal matrix is a promising technique to repair fistula with surrounding scarring, but larger, prospective trials are needed to confirm its potential benefits.