González-Sánchez Jorge Glicerio, Jiménez-Barragán Karina
Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, México.
Acta Otorrinolaringol Esp. 2011 Nov-Dec;62(6):448-53. doi: 10.1016/j.otorri.2011.06.006. Epub 2011 Aug 19.
Fistulas represent a significant challenge in the treatment of cleft palate. The best outcome of a palatoplasty is obtained with a competent velopharyngeal sphincter and a palate without fistulas. The recurrence of primary cleft palate fistula is reported as high as up to 76%, and to nearly 100% in recurrent fistulas. Plasma rich in growth factors (PRGF) is an autologous blood product with biologically active substances that enhance tissue repair mechanisms such as chemotaxis, cell proliferation, angiogenesis, osteogenesis and remodeling. Its use in cleft palate fistulas has not been reported. Our objective was to evaluate closure of recurrent cleft palate fistulas using PRGF mixed with autologous bone graft.
An experimental, prospective, longitudinal study was carried out from April 2008 to July 2010 on 11 recurrent cleft palate fistulas that were closed with local mucoperiosteal flaps and placement of autologous bone graft mixed with PRGF.
Complete closure of palate fistulas was achieved in 90.9% (follow-up of 6-24 months), decreasing the reported incidence for the recurrence by other authors with other techniques.
The use of PRGF mixed with autologous bone graft seems to be an effective, safe and low-cost technique for the closure of recurrent cleft palate fistulas. However, we consider its study must be extended.
瘘管是腭裂治疗中的一项重大挑战。腭裂修复术的最佳效果是拥有一个功能正常的腭咽括约肌且腭部无瘘管。据报道，原发性腭裂瘘管的复发率高达76%，而复发性瘘管的复发率接近100%。富含生长因子的血浆（PRGF）是一种自体血液制品，含有生物活性物质，可增强组织修复机制，如趋化作用、细胞增殖、血管生成、骨生成和重塑。其在腭裂瘘管中的应用尚未见报道。我们的目的是评估使用PRGF混合自体骨移植来闭合复发性腭裂瘘管的效果。
2008年4月至2010年7月，对11例复发性腭裂瘘管进行了一项实验性、前瞻性、纵向研究，采用局部黏骨膜瓣并植入混合PRGF的自体骨移植来闭合瘘管。
90.9%的腭裂瘘管实现了完全闭合（随访6 - 24个月），降低了其他作者使用其他技术报道的复发率。
使用PRGF混合自体骨移植似乎是一种有效、安全且低成本的闭合复发性腭裂瘘管的技术。然而，我们认为对其研究必须进一步扩展。
