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We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow\u2019s double opposing z-plasty) in Seoul National University Children\u2019s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18\u00a0months) were analyzed. The average cleft width was 7.0\u00a0mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9\/244). Palatal ratio (p\u2009=\u20090.014) and cleft width (p\u2009=\u20090.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25\u00a0mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0\/5, 1\/6 (16.7%), and 4\/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.<\/jats:p>","DOI":"10.1038\/s41598-020-72046-y","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T21:28:45Z","timestamp":1600378125000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effect of collagen matrix on postoperative palatal fistula in cleft palate repair"],"prefix":"10.1038","volume":"10","author":[{"given":"Jeong Hyun","family":"Ha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeonwoo","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youn Taek","family":"Koo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungmi","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeehyeok","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukwha","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"72046_CR1","doi-asserted-by":"publisher","first-page":"2361","DOI":"10.1097\/01.prs.0000218788.44591.f0","volume":"117","author":"ER Helling","year":"2006","unstructured":"Helling, E. 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