Secondary Cleft Lip Reconstruction and the Use of Pedicled, Deepithelialized Scar Tissue

Abstract

Background: The optimal time to create symmetry in a cleft lip is during primary repair; a secondary effort later is more difficult due to potential scarring and possible tissue deficiency of the repaired cleft lip. A plethora of methods for secondary correction have been described that have the goal of constructing the philtral column, ameliorating bad scar results, and augmenting lip volume, for example. Nevertheless, there is no single procedure that yields completely satisfactory results. In addition, the appropriate timing for secondary surgical corrections of the cleft lip is still under debate.

Methods: We present a new technique for secondary lip reconstruction of unilateral and bilateral cleft patients using pedicled, de-epithelialized cleft scar tissue as an autologous graft to obtain sustainable lip volume. Our results were evaluated by physicians and patient-parent satisfaction surveys.

Results: The esthetic outcomes of 29 patients were assessed using a patient satisfaction questionnaire and a physician survey based on the preoperative and postoperative clinical images. The success of the procedure was evaluated using a 5-point scale. The total scores of both the physician and patient assessments were high, although no correlation was found between the scores.

Conclusions: Cleft lip reconstruction using pedicled, deepithelialized scar tissue leads to excellent physician and patient satisfaction scores; this technique can be executed at any patient age and as a secondary repair for any given primary type of cleft disorder.

Figures

Fig. 1.

Excising partially the cleft scar.

Fig. 2.

Careful deepithelialization of the cleft scar with preservation of a vital inferior pedicle.

Fig. 3.

The graft site is prepared by blunt tunneling.

Fig. 4.

A braided resorbable suture is placed on the distal end of the graft to keep the correct position.

Fig. 5.

The skin and mucosa margins are trimmed and reapproximated such that the suture lines will become the future boarders of the philtrum.

Fig. 6.

Age, treatment, and sex distribution from the studied patient population together with the total satisfaction scores per group.