Upper Triangular Flap Method For Primary Repairs Of Incomplete Unilateral Cleft Lip Patients: Minor To Two-Thirds Way Defects

Structured abstract

Background: Incomplete unilateral cleft lips show a wide range of deformities, ranging from microform to near complete clefts. Since there are different amounts and qualities of tissue present on the cleft and non-cleft sides, surgical approaches should make distinctions based on the remnant tissue. A new procedure using an upper triangular flap that combines characteristics of both rotation advancement and straight line repair was applied and the surgical results were reviewed.

Methods: Between June, 2007 and April, 2011, 28 patients with minor to two-thirdsway unilateral cleft lips(minor (n=12); one-third (n=2); halfway (n=11); and two-thirdsway(n=3)) were subjected to the upper triangular flap method. The patients ranged in age from 62 days to 6 years(mean, 9 months). The average follow-up period was 25 months (ranging from 12 to 60 months).

Results: The repairs were successful in all 28 patients without complications. The scar was acceptable because it

ran along the vertical philtral columns. During the follow-up period, long lip deformities and Cupid's bow drooping were not observed in any of the patients. However, misalignment of the white skin roll was observed due to insufficient rotation at the cleft side in one patient.

Conclusions: The repairs of minor to two-thirdsway unilateral cleft lips using the upper triangular flap method allowed for a symmetric Cupid's bow and philtrum. Moreover, this method allowed for satisfactory nostril sill reconstruction with acceptable scarring. The upper triangular flap method is recommended as an alternative to conventional methods for repair of minor to two-thirdsway incomplete unilateral cleft lips.

Fig. 1. Intraoperative illustration. (a: columellar base; b: non-cleft side white skin roll upper border; c: cleft side nostril sill; d: the lowest point of the upper triangular flap; e: cleft side white skin roll upper border; f: the corresponding point ;g: non-cleft side white skin roll lower border;h: cleft side white skin roll lower border) The difference between the lip heights of the cleft and non-cleft side corresponds to the base length of triangle. The distance between b and g matches with between e and h, between a and b matches with between d and e between f and a matches with between c and d.

Fig. 2. A photo taken 9 months after the operation shows the successful results