Analysis of risk factors affecting poor wound healing after primary cleft palate surgery

doi:10.7518/hxkq.2023.2023117

Abstract

Abstract:

Objective To study the risk factors of poor wound healing after primary cleft palate surgery. Methods In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient’s age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor’s seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. Results A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor’s seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Conclusion Doctor’s seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

Key words: cleft palate, primary surgery, poor wound healing, risk factor

CLC Number:

R 782.2⁺2

Wu Min, Yin Heng, Chen Lixian, Shi Bing, Li Yang.. Analysis of risk factors affecting poor wound healing after primary cleft palate surgery[J]. West China Journal of Stomatology, 2023, 41(6): 719-724.

Figures/Tables 3

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References 33

1	石冰. 腭裂术后瘘孔的临床研究进展[J]. 国外医学口腔医学分册, 1999, 26(3): 174-176, 191.
	Shi B. Progress of clinical research on fistula after cleft palate operation[J]. Foreign Med Sci (Stomatol), 1999, 26(3): 174-176, 191.
2	Maeda K, Ojimi H, Utsugi R, et al. A T-shaped musculomucosal buccal flap method for cleft palate surgery[J]. Plast Reconstr Surg, 1987, 79(6): 888-896.
3	Senders CW, Sykes JM. Modifications of the Furlow palatoplasty (six- and seven-flap palatoplasties)[J]. Arch O-tolaryngol Head Neck Surg, 1995, 121(10): 1101-1104.
4	Inman DS, Thomas P, Hodgkinson PD, et al. Oro-nasal fistula development and velopharyngeal insufficiency fol-lowing primary cleft palate surgery: an audit of 148 children born between 1985 and 1997[J]. Br J Plast Surg, 2005, 58(8): 1051-1054.
5	Phua YS, de Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004[J]. Cleft Palate Craniofac J, 2008, 45(2): 172-178.
6	Lu Y, Shi B, Zheng Q, et al. Incidence of palatal fistula after palatoplasty with levator veli palatini retropositio-ning according to Sommerlad[J]. Br J Oral Maxillofac Surg, 2010, 48(8): 637-640.
7	Landheer JA, Breugem CC, van der Molen AB. Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure[J]. Cleft Palate Craniofac J, 2010, 47(6): 623-630.
8	Muzaffar AR, Byrd HS, Rohrich RJ, et al. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair[J]. Plast Reconstr Surg, 2001, 108(6): 1515-1518.
9	Schultz RC. Management and timing of cleft palate fistula repair[J]. Plast Reconstr Surg, 1986, 78(6): 739-747.
10	Amaratunga NA. Occurrence of oronasal fistulas in ope-rated cleft palate patients[J]. J Oral Maxillofac Surg, 1988, 46(10): 834-838.
11	Andersson EM, Sandvik L, Semb G, et al. Palatal fistulas after primary repair of clefts of the secondary palate[J]. Scand J Plast Reconstr Surg Hand Surg, 2008, 42(6): 296-299.
12	Mackay D, Mazahari M, Graham WP, et al. Incidence of operative procedures on cleft lip and palate patients[J]. Ann Plast Surg, 1999, 42(4): 445-448.
13	Pulkkinen J, Haapanen ML, Paaso M, et al. Velopharyngeal function from the age of three to eight years in cleft palate patients[J]. Folia Phoniatr Logop, 2001, 53(2): 93-98.
14	石冰. 腭裂的个体化整复[J]. 国际口腔医学杂志, 2015, 42(6): 621-623.
	Shi B. Individualized surgical management of cleft pa-late[J]. Int J Stomatol, 2015, 42(6): 621-623.
15	鲁勇, 石冰, 郑谦, 等. Sommerlad腭帆提肌重建术在不完全腭裂修复中的应用[J]. 临床口腔医学杂志, 2006, 22(4): 233-236.
	Lu Y, Shi B, Zheng Q, et al. A study of Sommerlad palatoplasty with the levator veli palatini retropositioning for isolated cleft palate repair[J]. J Clin Stomatol, 2006, 22(4): 233-236.
16	Smarius BJ, Breugem CC. Use of early hard palate closure using a vomer flap in cleft lip and palate patients[J]. J Craniomaxillofac Surg, 2016, 44(8): 912-918.
17	谢思田, 张万聪, 彭立红, 等. Furlow反向双Z法腭裂修复术后腭瘘发生率的研究[J]. 中国美容医学, 2010, 19(8): 1146-1148.
	Xie ST, Zhang WC, Peng LH, et al. Incidence of cleft palate fistula after Furlow’s double-opposing Z-palatoplasty[J]. Chin J Aesthetic Med, 2010, 19(8): 1146-1148.
18	傅敏刚. 70例腭裂疗效分析[J]. 上海第二医科大学学报, 2000, 20(Z1): 86-87.
	Fu MG. Effect analysis of 70 cases with cleft palate[J]. Acad J Shanghai Second Med Univ, 2000, 20(Z1): 86-87.
19	王洪涛, 黎凡. 早期腭裂修复术后瘘的发生率研究[J]. 中华整形外科杂志, 2003, 19(3): 192-194.
	Wang HT, Li F. Clinical study on fistula incidence of early cleft palate repair[J]. Chin J Plast Surg, 2003, 19(3): 192-194.
20	余东升, 黄洪章, 潘朝斌, 等. 131例腭裂修复术近期并发症分析[J]. 临床口腔医学杂志, 2004, 20(2): 101-102.
	Yu DS, Huang HZ, Pan CB, et al. Clinical analysis of early complications in the treatment of 131 cases of palatal repairs[J]. J Clin Stomatol, 2004, 20(2): 101-102.
21	肖小娜, 王绥江, 金玉丹, 等. 腭裂修复术后并发症417例分析[J]. 广东医学院学报, 2006, 24(1): 64-65.
	Xiao XN, Wang SJ, Jin YD, et al. Analysis of 417 cases of complications after cleft palate repair[J]. J Guangdong Med Coll, 2006, 24(1): 64-65.
22	吴敏, 朱祉冰, 石冰, 等. 华西Sommerlad-Furlow腭裂修复术后腭瘘率的研究[J]. 华西口腔医学杂志, 2020, 38(2): 166-169.
	Wu M, Zhu ZB, Shi B, et al. Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty[J]. West China J Stomatol, 2020, 38(2): 166-169.
23	石冰, 尹恒. 改进腭裂术后腭瘘发生率的表述与统计方法的建议[J]. 中华口腔医学杂志, 2013, 48(8): 499-501.
	Shi B, Yin H. Suggestions for improving the expression and statistical methods of the incidence of palatal fistula after cleft palate surgery[J]. Chin J Stomatol, 2013, 48(8): 499-501.
24	Ruberg RL. Role of nutrition in wound healing[J]. Surg Clin North Am, 1984, 64(4): 705-714.
25	Guo S, Dipietro LA. Factors affecting wound healing[J]. J Dent Res, 2010, 89(3): 219-229.
26	Elsherbiny A, Grant JH. Total palatal mobilization and multilamellar suturing technique improves outcome for palatal fistula repair[J]. Ann Plast Surg, 2017, 79(6): 566-570.
27	Rothermel AT, Lundberg JN, Samson TD, et al. A toolbox of surgical techniques for palatal fistula repair[J]. Cleft Palate Craniofac J, 2021, 58(2): 170-180.
28	Parwaz MA, Sharma RK, Parashar A, et al. Width of cleft palate and postoperative palatal fistula: do they correlate[J]. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1559-1563.
29	Cheng H, Chen BP, Soleas IM, et al. Prolonged operative duration increases risk of surgical site infections: a systematic review[J]. Surg Infect (Larchmt), 2017, 18(6): 722-735.
30	Li GQ, Guo FF, Ou Y, et al. Epidemiology and outcomes of surgical site infections following orthopedic surgery[J]. Am J Infect Control, 2013, 41(12): 1268-1271.
31	Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery[J]. Anesth Analg, 1999, 89(2): 514-519.
32	Hoekstra LT, van Trigt JD, Reiniers MJ, et al. Vascular occlusion or not during liver resection: the continuing story[J]. Dig Surg, 2012, 29(1): 35-42.
33	Willis-Owen CA, Konyves A, Martin DK. Factors affec-ting the incidence of infection in hip and knee replacement: an analysis of 5 277 cases[J]. J Bone Joint Surg Br, 2010, 92(8): 1128-1133.

项目		n	正常愈合/（n/%）	延迟愈合/（n/%）	腭瘘/（n/%）	P值
性别	女性	550	468/85.0	63/11.5	19/3.5	0.271
	男性	430	357/83.0	49/11.4	24/5.6
裂隙类型	硬软腭裂	625	539/84.5	73/11.4	26/4.1	0.761
	单侧完全性腭裂	51	179/82.5	28/12.9	10/4.6
	双侧完全性腭裂	81	107/85.6	11/8.8	7/5.6
医生年资	高年资	152	133/87.5	13/8.6	6/3.9	<0.001
	中年资	632	555/87.8	56/8.9	21/3.3
	低年资	196	137/69.9^#	43/21.9^#	16/8.2*
术前使用抗生素	是	526	448/85.2	57/10.8	21/4	0.643
	否	454	377/83.0	55/12.1	22/4.8
术中使用松弛切口	是	94	81/86.2	11/11.7	2/2.1	0.531
	否	886	744/84.0	101/11.4	41/4.6
术后上呼吸道感染	有	172	136/79.1	28/16.3	8/4.7	0.083
术后上呼吸道感染	无	808	689/85.3	84/10.4	35/4.3

变量	正常愈合	延迟愈合	腭瘘	P值
年龄/岁	0.88（0.64~2.04）	0.88（0.64~1.34）	0.88（0.64~3.46）	0.694
体重/kg	9（8.25~12.0）	9（8~11.1）	9（7.95~11.9）	0.372
术前白细胞计数/（×10⁹/L）	9.04（7.45~11.41）	9.68（7.91~11.84）	8.87（7.38~10.16）	0.118
术前血红蛋白水平/（g/L）	124（116~130）	123（116.5~130）	123（113.5~131）	0.943
裂隙最宽处宽度/mm	11（9~13）	11（9~13）	12（9.5~15）	0.014
上颌结节平面后缘宽度/mm	34（31~38）	34（30~38）	35（32~38.5）	0.490
腭裂指数	0.301（0.258~0.375）	0.321（0.276~0.394）	0.342（0.281~0.417）	0.022
手术时长/min	75（60~90）	85（70~100）	95（80~110）	<0.001

变量		OR	95%CI	P值
延迟愈合	手术时长	1.008	1.000~1.018	0.064
	医生年资
	高年资	0.418	0.206~0.850	0.016
	中年资	0.293	0.177~0.484	<0.001
	低年资	参照
	裂隙最宽处宽度	1.056	0.913~1.221	0.461
	腭裂指数	1.079	0.026~45.059	0.968
腭瘘	手术时长	1.017	1.004~1.030	0.008
	医生年资
	高年资	0.591	0.209~1.671	0.321
	中年资	0.324	0.150~0.701	0.004
	低年资	参照
	裂隙最宽处宽度	1.037	0.919~1.169	0.556
	腭裂指数	8.915	0.818~97.170	0.073

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