Islandization of Hemipalatal Flaps and Lateral Relaxing Incisions in Palatoplasty

Abstract

Sir: We read with interest the article entitled “Superior Results Using the Islandized Hemipalatal Flap in Palatoplasty: Experience with 500 Cases” by Bindingnavele et al., published in Plastic and Reconstructive Surgery in 2008.1 We also realized that the study was presented at two plastic surgery meetings in the United States in 2001. In their article, the authors mentioned that the islandization of the hemipalatal flaps (332 cases) and lateral relaxing incisions (168 cases) are able to close the hard palate clefts without tension after having the standard double-opposing Z-plasty procedures performed in soft palatal portions of the cleft. The authors also emphasized the lower fistula formation rate by this approach and declared that they would analyze their data in terms of velopharyngeal insufficiency and maxillary growth. Our generation has been familiar with the double-opposing Z-plasty cleft palate repair, described by Furlow in 1986.2 Afterward, almost the world over, including in Turkey, the technique was considered as a revolution in cleft palate repair, after two classic techniques, those of von Langenbeck and Veau-Wardill-Kilner. The majority of the cleft palate surgeons have applied this new technique, and in time this technique has been evaluated as a good approach in narrow clefts. Dr. Cihandide met Dr. Leonard Furlow during the Activation by Rotaplast, held in Maracaibo, Venezuela, between August 30 and September 10, 2000. As known, this activation was related to only cleft lip and palate surgery. Dr. Angelo Capozzi was the chief of the classic cleft team with 44 people. Surprisingly, Dr. Furlow was in the team with another five plastic surgeons. During the activation, 225 children were examined by the team and 182 of them were operated on. More than half of the patients were cleft palate cases and all cases underwent repair by means of Dr. Furlow’s technique. Because it was like a cleft lip and palate school, Dr. Cihandide was able to observe almost all of the details and steps of the technique first hand. This is why he felt himself to be very lucky. During the activation, Dr. Cihandide observed that the islandization procedure was a routine step, achieved through a certain order of his technique, especially in large clefts. Possibly, Dr. Furlow was doing this before 2000, the time at which Dr. Cihandide first observed it. Although more dissection and related early and late problems are inevitable in this approach, we congratulate the authors because their contribution can be considered as a confirmation of the step taken by Dr. Furlow. Adnan Uzunismail, M.D. Ercan Cihandide, M.D. Department of Plastic, Reconstructive, and Aesthetic Surgery Haydarpaşa Numune Training and Research Hospital Istanbul, Turkey