Furlow Commentary on Double Opposing Z-Plasty Procedure for Secondary Palatoplasty
Authors: Snyder-Warwick AL1, Furlow LT Jr2, Yee A1
Published: March 15, 2019
Author Information
1Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri, US
2Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida, US
Furlow Commentary (180515.180601)
ABSTRACT
The Furlow palatoplasty was first described by Leonard Furlow in 1986 as a double opposing Z-plasty technique for cleft palate repair. This technique is designed to reorientate the muscle fibers of the levator sling, lengthen the soft palate, and create a non-linear scar therefore limiting future shortening of the repaired palate secondary to scar contracture. Furlow’s technique is performed for both primary and secondary palatoplasty, in which addresses complications such as fistula development or persistent velopharyngeal insufficiency (VPI). VPI is a common complication after cleft palate repair due to palatal shortening and/or lack of levator sling reconstruction. In these cases, palate repair using Furlow’s technique restores transverse alignment and soft palate configuration similar to that produced during a primary Furlow repair. In this case, a 6-year-old female presents with VPI and incomplete, but asymmetric velar closure following a cleft palate repair at 15 months of age. The patient underwent a secondary palatoplasty with a Furlow double opposing Z-plasty to lengthen the soft palate and improve speech resonance difficulties. During the case, dissection was more difficult than normal given the dense and adherent scar tissue. A combination of sharp and blunt dissection is portrayed to elevate the necessary flaps. This video article includes commentary and surgical technique by Dr. Furlow.
TABLE OF CONTENTS (Standard)
00:00 Introduction
00:20 Marking Incision Limbs of Z-Plasty on Soft Palate
00:43 Lateral Relaxing Incisions and Blunt Dissection to the Hamulus
01:23 Midline Incision of Z-Plasty through Oral Mucosa
01:38 Sharp Dissection through the Submucosa and Velar Musculature
02:36 Left-sided Incision of Z-Plasty and Full-Thickness Dissection
03:13 Elevating the Left-sided Full-Thickness Flap with Sharp and Blunt Dissection
06:54 Visualizing the Left-sided Full-Thickness Flap
07:02 Right-sided Incision of Z-Plasty through Oral Mucosa
07:24 Elevating the Right-sided Mucosa Flap with Sharp Dissection
08:46 Visualizing the Right-sided Mucosa Flap
08:51 Midline Incision through the Nasal Mucosa
10:25 Incising the Nasal Mucosa to Create the Left-sided Mucosa Flap
10:58 Incising the Velar Musculature and Nasal Mucosa to Create the Right-sided Full-Thickness Flap
11:28 Demonstration of Transposed Flaps for Repair and Closure
12:06 Further Elevating the Right-sided Full-Thickness Flap
12:25 Closure of Nasal Z-Plasty of Right-sided Full Thickness Flap
13:36 Repair of Uvula and Posterior Closure of Nasal Z-Plasty
15:09 Anterior Closure of Oral Z-Plasty from the Uvula
16:07 Anchor Suture of Oral Mucosa Flap
16:27 Closure of Nasal Z-Plasty of Left-sided Mucosa Flap
18:34 Closure of Oral Z-Plasty of Left-sided Full-Thickness Flap
19:44 Closure of Oral Z-Plasty of Right-sided Mucosa Flap
22:00 Copious Irrigation and Completion of Furlow Palatoplasty
22:12 Credits
