"Flip-over flap" in two-stage cleft palate repair.

PURPOSE: This study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge ("flip-over") flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991.

MATERIALS AND METHODS: The concept entails Furlow soft palate repair (at 1 year of age) and hard palate closure (at 4 years) by a three-pronged approach [paring of the edges with or without postero-lateral relaxing incisions, peninsula (Veau) flap(s)], plus a triangular hinge flap. The latter is elevated from the oral layer of the already-repaired soft palate, stays based anteriorly, and is flipped over to close the posterior nasal layer defect. The case series is compared with data from the literature.

RESULTS: The palatal fistula rate for Veau II to IV types (two-stage surgeries) was 4.3%. The overall fistula rate in the cleft population (Veau I-IV) was 2.9%. Meta-analyses describe 4.9 and 8.6% on average. There was no difference between sample A in which the flip-over flaps were used only when modified Veau flaps were indicated (until 2006) and sample B in which it was used regardless of the technique of hard palate closure applied (2006-2018). The fistula rate decreased to zero after 2010, which may reflect also an influence of other factors such as the interpositioning of a collagen membrane and also of improved surgical judgment.

CONCLUSIONS: Using a flip-over flap in two-stage cleft palate repair may contribute to prevent fistula formation at the hard/soft palate junction.

LEVEL OF EVIDENCE: III.