Cierre de fístulas nasopalatinas recurrentes con plasma rico en factores de crecimiento en pacientes con paladar hendido / Closure of recurrent cleft palate fistulas with plasma rich in growth factors

Introducción y objetivo: Las fístulas palatinas representan un desafío importante en el tratamiento del paladar hendido. Los mejores resultados de una palatoplastia se obtienen con un esfínter velofaríngeo competente y un paladar sin fístulas. En la literatura se describe que la recurrencia de fístulas palatinas primarias es de hasta el 76% y las recurrentes es de aproximadamente el 100%. El plasma rico en factores de crecimiento (PRGF) es un hemoderivado autólogo con sustancias biológicamente activas que promueven los mecanismos de reparación tisular como quimiotaxis, proliferación celular, angiogénesis, osteogénesis y remodelación. No se ha descrito su uso en reparación de fístulas nasopalatinas. Nuestro objetivo fue evaluar el cierre exitoso de fístulas palatinas recurrentes con el uso del PRGF combinado con injerto óseo autólogo. Pacientes y método: Se realizó un estudio experimental, prospectivo, longitudinal desde abril 2008 a julio 2010, con un total de 11 fístulas nasopalatinas, las cuales se cerraron por medio de colgajos mucoperiósticos locales y colocación de injerto óseo autólogo mezclado con PRGF. Resultados: Con un seguimiento de 6-24 meses, se demostró el cierre completo de las fístulas en el 90,9%, disminuyendo el índice de recurrencia descrito con otras técnicas por otros autores. Conclusión: El uso de PRGF mezclado con injerto óseo autólogo parece ser una alternativa eficaz, segura y de bajo costo para el cierre de fístulas palatinas, sin embargo su estudio debe ser ampliado (AU)

Introduction and objective: 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. Methods: 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. Results: Complete closure of palate fistulas was achieved in 90.9% (follow-up of 6-C24 months), decreasing the reported incidence for the recurrence by other authors with other techniques. Conclusions: 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 (AU)

[Closure of recurrent cleft palate fistulas with plasma rich in growth factors]. / Cierre de fístulas nasopalatinas recurrentes con plasma rico en factores de crecimiento en pacientes con paladar hendido.

INTRODUCTION AND OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.