Modification of the repair of a unilateral cleft lip.J Craniofac Surg 2008; 19(5):1330-42JC
The ideally repaired cleft lip should provide a symmetrical Cupid's bow, philtrum, and minimal scar. In the appearance of the upper lip, the philtrum plays a key role. The most popular method for unilateral cleft lip repair is the rotation advancement technique introduced by Millard. This technique requires the rotation of the non-cleft-side flap in a unilateral cleft lip. As the vertical discrepancy between the peaks of Cupid's bow is increased, the scarring becomes more evident. Also, where it crosses the philtral column in the oblique extension of the upper lip, it becomes apparent for the eye to notice. Thus, many surgeons have tried to modify this technique to improve the symmetry of the philtral columns. Therefore, I developed my technique, called the E (reversed) M (sided) skin extension (EMSEN) repair, including 2 perpendicular incisions in rotation flap and 2 equilateral flaps in advancement flap and muscle repositioning. We carried out the EMSEN technique to 20 consecutive (9 boys and 11 girls) patients with unilateral cleft. The mean age at repair was 10.1 years (range, 3 months to 18 years). The postoperative outcomes were assessed with the subjective and objective scar assessment test. The mean follow-up time was 24.5 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. Three plastic surgeon committee members (randomized selected) reviewed the analysis of the color, texture, width, and thickness of the scar. It was found that most members of the plastic surgeon committee and patients or parents were very good and very happy, respectively. We eradicated some shortcomings in Millard's technique with this technique. E (reversed) M (sided) skin extension repair lengthens the vertical lip using the E-M flaps, resulting in a nonlinear incision such as W-plasty scar on the philtral ridge and forming symmetrical Cupid's bow, superior to Millard repair.