Montreal, Quebec, Canada From the Division of Plastic and Reconstructive Surgery, McGill University Health Center, H. B. Williams Craniofacial and Cleft Surgery Unit, Montreal Children's Hospital.
Plast Reconstr Surg. 2012 Jul;130(1):177-182. doi: 10.1097/PRS.0b013e318254b2dc.
The repair of wide cleft palates and secondary palatal fistulas remains a challenge for pediatric plastic surgeons. To reduce the incidence of fistulization, use of acellular dermal matrix to facilitate closure has been reported in the literature. A review of the literature was performed to assess whether sufficient evidence exists to recommend the routine use of acellular dermal matrix for either primary palatoplasty or secondary palatal fistula repair.
A literature search for the period between 1970 and 2011 was performed. All articles with clinical application of acellular dermal matrix in primary palatoplasty or palatal fistula repair were included. Data were analyzed using weighted averages to compare fistula rates between repairs performed with and without acellular dermal matrix (historical controls) for each repair type (primary versus secondary fistula repairs).
Four studies examined the use of acellular dermal matrix in primary palatoplasty (n = 92) with a mean cleft width of 14.2 mm. The overall fistula rate was 5.4 percent compared with 10.6 percent in the non-acellular dermal matrix historical control group. Five studies used acellular dermal matrix in palatal fistula repair (n = 74). The overall recurrent fistula rate was 8.1 percent compared with 12.9 percent in the historical control group.
Based on the available data, the results imply that acellular dermal matrix may have a potential benefit in reducing fistula formation/persistence in palate surgery. However, the authors did not find sufficient prospective randomized (level II or better) evidence to recommend the routine use of acellular dermal matrix for cleft palate repair.
宽腭裂及继发腭裂瘘的修复仍然是小儿整形外科医生面临的挑战。为了降低瘘管形成的发生率，文献报道使用脱细胞真皮基质来促进闭合。我们对文献进行了回顾，以评估是否有足够的证据推荐常规使用脱细胞真皮基质进行初次腭裂修复或继发腭裂瘘修复。
对 1970 年至 2011 年期间的文献进行了检索。所有在初次腭裂修复或腭裂瘘修复中应用脱细胞真皮基质的临床应用文章均被纳入。使用加权平均值对数据进行分析，以比较每种修复类型（初次与继发瘘管修复）中使用和不使用脱细胞真皮基质（历史对照）修复的瘘管发生率。
4 项研究检查了脱细胞真皮基质在初次腭裂修复（n = 92）中的应用，平均腭裂宽度为 14.2mm。总的瘘管发生率为 5.4%，而历史对照中非脱细胞真皮基质组的发生率为 10.6%。5 项研究在腭裂瘘修复中使用了脱细胞真皮基质（n = 74）。总的复发性瘘管发生率为 8.1%，而历史对照中非脱细胞真皮基质组的发生率为 12.9%。
根据现有数据，结果表明脱细胞真皮基质可能在减少腭裂手术中瘘管形成/持续方面具有潜在的益处。然而，作者并未发现足够的前瞻性随机对照（II 级或更高级别）证据推荐常规使用脱细胞真皮基质进行腭裂修复。
