Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair
Abstract
:1. Introduction
2. Methods of the Study
2.1. Patient Cohort
2.2. Surgical Technique
2.3. Photograph Evaluation Protocol
2.4. Scar Scoring Parameters
2.5. Data Collection
2.6. Statistical Analysis
3. Results
3.1. Patient Demographics
3.2. Preoperative Diagnoses
3.3. Concurrent Procedures
3.4. Postoperative Clinical Outcomes
3.5. Scar Scores
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Sitzman, T.J.; Verhey, E.M.; Kirschner, R.E.; Pollard, S.H.; Baylis, A.L.; Chapman, K.L.; Cleft Outcomes Research NETwork (CORNET) Consortium. Cleft Palate Repair Postoperative Management: Current Practices in the United States. Cleft Palate Craniofac. J. 2024, 61, 827–833. [Google Scholar] [CrossRef] [PubMed]
- The Children’s Hospital of Philadelphia. Cleft Lip and Palate Repair Surgery. Children’s Hospital of Philadelphia. 5 May 2014. Available online: https://www.chop.edu/treatments/surgical-repair-cleft-lip-and-palate (accessed on 23 April 2023).
- Pujol, G.; Riera March, A. Cleft Lip Repair. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2022. [Google Scholar]
- American Cleft Palate-Craniofacial Association. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Cleft Palate Craniofac. J. 1993, 30, S1–S16. [Google Scholar]
- Michelotti, B.; Long, R.E.; Leber, D.; Samson, T.; Mackay, D. Should surgeons use arm restraints after cleft surgery? Ann. Plast. Surg. 2012, 69, 387–388. [Google Scholar] [CrossRef] [PubMed]
- Huth, J.; Petersen, J.D.; Lehman, J.A. The use of postoperative restraints in children after cleft lip or cleft palate repair: A preliminary report. ISRN Plast Surg. 2013, 2013, 540717. [Google Scholar] [CrossRef]
- Ranzer, M.; Daniele, E.; Purnell, C.A. Perioperative Management of Cleft Lip Repair: A Meta-Analysis and Clinical Practice Guideline. Cleft Palate Craniofac. J. 2021, 58, 1217–1225. [Google Scholar] [CrossRef] [PubMed]
- Katzel, E.B.; Basile, P.; Koltz, P.F.; Marcus, J.R.; Girotto, J.A. Current surgical practices in cleft care: Cleft palate repair techniques and postoperative care. Plast Reconstr. Surg. 2009, 124, 899–906. [Google Scholar] [CrossRef] [PubMed]
- Noordhoff, M.S.; Chen, P.K.T. Volume 4: Pediatric plastic surgery. 93 unilateral cheiloplasty. In Mathes: Plastic Surgery, 1st ed.; McCarthy, J.G., Ed.; Saunders: Philadelphia, PA, USA, 2006; pp. 165–216. [Google Scholar]
- Hopper, R.A.; Cutting, C.; Grayson, B. Cleft lip and palate. In Grabb & Smith’s Plastic Surgery, 6th ed.; Thome, C.H., Ed.; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2007; pp. 201–225. [Google Scholar]
- Hasanzadeh, N.; Khoda, M.O.; Jahanbin, A.; Vatankhah, M. Coping strategies and psychological distress among mothers of patients with nonsyndromic cleft lip and palate and the family impact of this disorder. J. Craniofac. Surg. 2014, 25, 441–445. [Google Scholar] [CrossRef] [PubMed]
- Mecott, G.A.; Finnerty, C.C.; Herndon, D.N.; Al-Mousawi, A.M.; Branski, L.K.; Hegde, S.; Kraft, R.; Williams, F.N.; Maldonado, S.A.; Rivero, H.G.; et al. Reliable scar scoring system to assess photographs of burn patients. J. Surg. Res. 2015, 199, 688–697. [Google Scholar] [CrossRef] [PubMed]
- O’Riain, S. Cleft lip surgery without postoperative restraints. Br. J. Plast. Surg. 1977, 30, 140–141. [Google Scholar] [CrossRef] [PubMed]
- Jigjinni, V.; Kangesu, T.; Sommerlad, B.C. Do babies require arm splints after cleft palate repair? Br. J. Plast Surg. 1993, 46, 681–685. [Google Scholar] [CrossRef] [PubMed]
- Tokioka, K.; Park, S.; Sugawara, Y.; Nakatsuka, T. Video recording study of infants undergoing primary cheiloplasty: Are arm restraints really needed? Cleft Palate Craniofac. J. 2009, 46, 494–497. [Google Scholar] [CrossRef] [PubMed]
- Smith, R.M. Psychological problems related to speech and language development. In Cleft Lip and Palate; Grabb, W.C., Rosenstein, S.W., Bzoch, K.R., Eds.; Little Brown and Company: Boston, MA, USA, 1971; p. 708. [Google Scholar]
- Millard, R.D. Cleft Craft: The Evolutlon of Its Surgery; Little Brown and Company: Boston, MA, USA, 1976; Volume III, lU80: Ii9 63. [Google Scholar]
- Preidl, R.H.M.; Kesting, M.; Rau, A. Perioperative management in patients with cleft lip and palate. J. Craniofac. Surg. 2020, 31, 95–101. [Google Scholar] [CrossRef] [PubMed]
- Brown, B.C.; McKenna, S.P.; Siddhi, K.; McGrouther, D.A.; Bayat, A. The hidden cost of skin scars: Quality of life after skin scarring. J. Plast. Reconstr. Aesthet. Surg. 2008, 61, 1049–1058. [Google Scholar] [CrossRef] [PubMed]
- Al-Benna, S.; Bruce-Chwatt, A. Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients. Plast. Reconstr. Surg. 2021, 147, 61e–68e. [Google Scholar] [CrossRef] [PubMed]
- Eisemann, B.S.; Kantar, R.S.; Ramly, E.P.; Alfonso, A.R.; Wang, M.; Flores, R.L. Qualitative Assessment of Columella Scar Quality After Extended Mohler Unilateral Cleft Lip Repair. J. Craniofac. Surg. 2019, 30, 2194–2197. [Google Scholar] [CrossRef] [PubMed]
- Yeong, E.K.; Mann, R.; Engrav, L.H.; Goldberg, M.; Cain, V.; Costa, B.; Moore, M.; Nakamura, D.; Lee, J. Improved burn scar assessment with use of a new scar-rating scale. J. Burn Care Rehabil. 1997, 18, 353–355, discussion 352. [Google Scholar] [CrossRef] [PubMed]
- Baryza, M.J.; Baryza, G.A. The Vancouver Scar Scale: An administration tool and its interrater reliability. J. Burn Care Rehabil. 1995, 16, 535–538. [Google Scholar] [CrossRef] [PubMed]
Mittens | Restraints | p Value | |
---|---|---|---|
N = 28 | N = 27 | ||
n (%) | n (%) | ||
Sex | 0.121 | ||
Male | 22 (78.6) | 16 (56.3) | |
Female | 6 (21.4) | 11(40.7) | |
Race and ethnicity | 0.906 | ||
White | 12 (42.9) | 12 (44.4) | |
Asian | 4 (14.3) | 3 (11.1) | |
Black | 3 (10.7) | 3 (11.1) | |
Other/not specified | 3 (10.7) | 5 (18.5) | |
Hispanic | 6 (14.3) | 4 (14.8) | |
Age at primary surgery | 3.5 (±0.7) | 3.8 (±0.7) | 0.041 |
months (±SD) | |||
Age at photograph | 23.9 (±5.8) | 28.9 (±11.1) | 0.239 |
months (±SD) | |||
Time between surgery and photograph | 20.4 (±5.9) | 25.10 (±11.3) | 0.317 |
months (±SD) |
Mittens | Restraints | p Value | |
---|---|---|---|
N = 28 | N = 27 | ||
n (%) | n (%) | ||
Laterality | |||
Left | 16 (57.1) | 19 (70.3) | |
Right | 12 (42.9) | 8 (29.7) | |
Cleft type | 0.0683 | ||
Complete | 17 (60.7) | 23 (85.2) | |
Incomplete | 11 (39.3) | 4 (14.8) | |
Cleft alveolus | 22 (78.5) | 25 (92.6) | 0.2516 |
Cleft palate | 16 (57.1) | 19(70.4) | 0.2795 |
Procedure name | |||
Extended Mohler cleft lip repair | 28 (100) | 29 (100) | |
Concurrent procedures | 0.7896 | ||
Primary cleft rhinoplasty | 28 (100) | 27 (100) | |
Gingivoperiosteoplasty | 13(46.4) | 14 (51.9) | |
Botox injection to upper lip | 4 (14.3) | 1 (3.7) | |
Tongue-tie release | 0 (0) | 1 (3.7) | |
Extraction of two teeth | 0 (0) | 1 (3.7) | |
Right inguinal hernia repair | 1 (3.7) | 0 (0) | |
Alveolar reconstruction | 1 (3.7) | 0 (0) | |
Bilateral myringotomy and tubes | 1 (3.7) | 0 (0) | |
Nasoalveolar molding (NAM) | 18 (64.3) | 24 (88.9) | 0.055 |
Post-op complications | 0.4909 | ||
Wound complications | 0 (0) | 0 (0) | |
Wheezing, upper respiratory infection | 0 (0) | 1 (3.7) | |
30-day readmissions | 0 (0) | 1 (3.7) | 0.4909 |
30-day reoperations | 0 (0) | 0 |
Mittens | Restraints | p Value | |
---|---|---|---|
Median (IQR) | Median (IQR) | ||
N = 28 | N = 27 | ||
Scar Surface Appearance Score | 1.61 (1.31–1.94) | 1.38 (1.26–1.71) | 0.067 |
Scar Height Score | 1.56 (1.39–2.00) | 1.48 (1.31–1.60) | 0.068 |
Scar Color Mismatch Score | 1.70 (1.32–1.99) | 1.60 (1.33–1.86) | 0.631 |
Total Scar Appearance Score | 4.89 (4.09–5.99) | 4.60 (4.05–5.02) | 0.198 |
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Verzella, A.N.; Laspro, M.; Diaz, A.; Cassidy, M.F.; Park, J.; Schechter, J.; Alcon, A.; Shetye, P.R.; Staffenberg, D.A.; Flores, R.L. Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair. J. Clin. Med. 2024, 13, 3619. https://doi.org/10.3390/jcm13133619
Verzella AN, Laspro M, Diaz A, Cassidy MF, Park J, Schechter J, Alcon A, Shetye PR, Staffenberg DA, Flores RL. Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair. Journal of Clinical Medicine. 2024; 13(13):3619. https://doi.org/10.3390/jcm13133619
Chicago/Turabian StyleVerzella, Alexandra N., Matteo Laspro, Allison Diaz, Michael F. Cassidy, Jenn Park, Jill Schechter, Andre Alcon, Pradip R. Shetye, David A. Staffenberg, and Roberto L. Flores. 2024. "Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair" Journal of Clinical Medicine 13, no. 13: 3619. https://doi.org/10.3390/jcm13133619
APA StyleVerzella, A. N., Laspro, M., Diaz, A., Cassidy, M. F., Park, J., Schechter, J., Alcon, A., Shetye, P. R., Staffenberg, D. A., & Flores, R. L. (2024). Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair. Journal of Clinical Medicine, 13(13), 3619. https://doi.org/10.3390/jcm13133619