Short stay after cleft palate surgery.

Although algorithms for the repair of soft and hard palatal clefts continue to be debated, the appropriate length of postoperative stay has not yet been defined. Recent reports of cleft palate repair advocate a 2- to 5-day hospitalization. The plastic surgery service at St. Joseph Hospital frequently uses same-day admission with 23-hour observation postoperatively, with no increase in complications from the reported 2- to 5-day stay. The authors inspected the records for all the cleft palate patients undergoing cleft repair at St. Joseph Hospital Cleft Clinic from August of 1988 through June of 1998. After excluding syndromic patients and secondary or revision surgical cases, 79 patients remained in the study. These 79 patients underwent 104 procedures; all procedures were performed by a single surgeon (E.D.C.) with resident assistance. Short-term morbidity, length of stay, and operation performed were studied. All patients were admitted the day of surgery. Mean age at the time of operation was 13.2 months, with a range of 6 months to 20 years. The length of operation averaged 1 hour and 37 minutes; 94 percent of patients stayed 24 hours or less postoperatively, and 97 percent stayed 36 hours or less. The longest stay was 72 hours, which was related to delay in resuming adequate oral intake. The overall complication rate was 3.8 percent for this cohort, which included two partial palatal dehiscences and two small fistulas. No blood transfusions were needed, and no infections were noted postoperatively. No patients required readmission postoperatively for bleeding, respiratory compromise, or inadequate oral intake. The authors do not advocate a 1-night stay for all cleft palate cases. However, they do think it is safe for a healthy group of patients undergoing routine cleft palate surgery. The decision to discharge a patient early must always be left to the treating physician.

Assessment of differential cytokine effects on angiogenesis using an in vivo model of cutaneous wound repair.

Angiogenesis, or new blood vessel formation, has been a subject of intense investigation in recent years. A major obstacle in this research has been the selection of an appropriate in vivo model with which comparisons to humans can be made as well as a reliable quantitative method. Using the porcine excisional wound healing model, we report a new and simple technique for obtaining objective assessments of the microvascular compartment. Factor VIII immunostaining of histological specimens was utilized for specific identification of endothelium devoid of background interference. This technique was coupled with morphometric analysis to quantitate the differential effects of tumor necrosis factor alpha (TNF alpha), transforming growth factor beta (TGF beta), basic fibroblast growth factor (bFGF), insulin-like growth factor-1 (IGF-1), and epidermal growth factor (EGF) within healing porcine wounds. All cytokines stimulated angiogenesis, with low dose TNF alpha and bFGF treatments exhibiting the most profound effects at 7 days postwounding. With increasing levels of TNF alpha (1 ng, 10 ng, 100 ng, and 2.5 micrograms), a step-wise decrease in microvascular area was noted. Although no significant dose responsive differences in angiogenesis were noted following bFGF treatments, a profound increase in capillary area was shown. Significant yet less dramatic increases were noted in capillary area following treatment with EGF or IGF-1. Comparison of the angiogenic effects of TGF beta at 7 and 10 days postwounding showed a significant decrease in the microvasculature as wounds matured. Our data are consistent with previous qualitative in vitro and in vivo reports, thereby confirming the validity of this new model. The data furthermore provide the first quantitative evidence of differential angiogenic responses to cytokines within a clinically relevant model of cutaneous wound repair.