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Should Surgeons Use Arm Restraints Follow Cleft Surgery?
Brett Michelotti, Donald Mackay, MD, Ross E. Long, DMD.
Milton S. Hershey Medical Center, Hershey, PA, USA.

Background: The vast majority of cleft surgeons require children to wear post-operative arm restraints in order to prevent traumatic disruption of the repaired cleft incision. Despite a number of smaller studies in the literature that report no difference in post-operative complications, a survey of cleft surgeons performed in 2009, revealed that 85% of respondents employed the use of such elbow immobilizing devices. 1-4
Objective: We attempt to further the literature in support of performing cleft surgery without the use of post-operative arm restraints.
Methods: This was a retrospective review of 200 patients undergoing primary repair of either cleft lip or cleft palate. The patients included in the study were consecutive cases from both a teaching institution and a private facility. After performing cleft surgery, one surgeon employed the use of arm restraints in all patients and the other surgeon did not require the use arm restraints in any of his patients. Demographic information was obtained including age, gender, timing of surgery, type of cleft and whether or not the cleft was associated with a known genetic abnormality. Immediate post-operative complications were reviewed and the two groups were compared statistically.
Results: In our review of 200 cleft surgeries, there was no significant difference in early post-operative complications in patients who were required to wear arm restraints versus those who were not (p < 0.05).
Discussion: Despite the evidence that post-operative arm restraints are not needed following cleft surgery, the vast majority of cleft surgeons still use them routinely. The review of our experience, with and without restraints following cleft surgery, supports the existing literature. Arm restraints are unnecessary and may cause distress in both patients and their families.
References: 1. Demay et. al. 1997. Early postoperative complications in primary cleft lip and palate surgery. Eur J plast surg 20:77-9.
2. Jigjinni et al. 1993. Do babies require arm splints after cleft palate repair? Brit J of Plast Surg. 46:681-5.
3. Katzel et al. 2009. Current Surgical Practices in Cleft Care: Cleft Palate Repair Techniques and Postoperative Care. Plast reconstr surg. 124: 899-906.
4. Tokioka et al. 2009. Video Recording Study of Infants Undergoing Primary Cheiloplasty: Are Arm Restraints Really Needed? Cleft Palate Craniofacial Journal. 46(5):494-7.


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