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Letting Go Under Control: Resident As Primary Surgeon For A Consecutive, Non-Selective Series of Furlow Palatoplasties
Thanapoom Boonipat, BS1, Cheryl Lundgren, CCC-SLP2, Mitchell Stotland, MD3.
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 3Geisel School of Medicine at Dartmouth, Sidra Medical Center, and Weill Cornell Medical College in Qatar, Hanover and Doha Qatar, NH, USA.

Purpose
Despite sound anatomic rationale, and evidence of clinical effectiveness, some surgeons consider the Furlow procedure technically challenging and difficult to teach - using it only selectively. The 2016 ABPS MoC cleft palate tracer data indicates only 14% of velar repairs achieved using the Furlow technique.
To measure the outcomes of a consecutive series of primary Furlow palatoplasties in which plastic surgical residents functioned as primary surgeon for all steps of all procedures under immediate supervision and guidance of the senior surgeon.
Methods
Retrospective review of 75 consecutive primary palatoplasties over a 6-year span. Plastic surgical residents performed the velar repair using the Furlow technique exclusively and non-selectively for all cleft palate patients (including syndromic). Stringent inclusion criterion for speech evaluation was employed (age > 54 mos) . Clinically relevant outcomes were measured.
Results
Median age at surgery: 11 months
Veau Classification: I (15%), II(45%), III(21%), IV(11%),
V(5%)
Fistula rate: 5.3%
Re-operation rate for fistula: 4%
Median age at final speech evaluation: 87 months
Incidence of hypernasal resonance > mild (2/6 score): 6.7%; nasal air emission: 0%; compensatory disarticulation: 13%
Re-operation rate for VPI-related symptoms: 4%
Average operative time (including myringotomies): 154 mins
Conclusions
The Furlow repair is effective for all cleft types and all patients.
These results demonstrate that plastic surgical residents performing the entire palatoplasty procedure under close supervision and guidance can achieve superior clinical outcomes.
Facilitating the hand over of procedural execution to a surgical trainee without ceding control or reducing safety or reliability is discussed.


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