Purpose: The double-opposing Z-plasty palatal repair, as reported by Dr Furlow, is one of the most popular methods of primary cleft palate repair. However, the repair as originally described is difficult to perform on wide palatal clefts. We have modified the original repair by altering the hard palatal flap design to allow for better mobilization and improved closure of the cleft. The purpose of this paper is to analyze the affect of this modification on the long term results of palatal cleft repair.

Methods: We performed a retrospective review of 500 consecutive children undergoing double-opposing Z-plasty cleft palate repairs with or without islandization of the hemi-palate on its vascular pedicle over a ten-year period at the Childrens Hospital Los Angeles. Children were evaluated based on their age at time of repair, extent of cleft, and occurrence of postoperative fistulae.

Results: Three hundred and thirty-two children underwent pedicle-lengthening while 168 children did not have pedicle lengthening. The overall fistula rate in this series was 5.0%. When the experience of the five cleft surgeons in this series were combined, patients undergoing pedicle lengthening had significantly lower fistula rates (2.1%) than patients undergoing palatoplasty without pedicle lengthening (10.6%). Patient gender, age, and extent of clefting did not correlate with the rate of fistula formation in this study. There was only one partial flap loss early in our series.

Conclusions: Our data suggests that a double-opposing Z-plasty palate repair performed with islandization results in lower postoperative fistula rates when compared to repair done without islandization.