Facial Plast Surg 2024; 40(05): 632-639
DOI: 10.1055/s-0043-1777866
Original Research

Utility of J-Shaped Scar Tissue-Based Flap for Secondary Bilateral Cleft Lip Repair: A One-Stage Procedure with Successful Outcomes on Correction of Vermilion Border, Volume Deficiency of Lip, and Muscular Function

1   Private Aesthetic Plastic and Reconstructive Surgery Office, Bursa, Türkiye
› Author Affiliations

Abstract

This study aimed to evaluate the utility of J-shaped scar-tissue-based flap as a new technique in secondary bilateral cleft lip reconstruction in patients with challenging secondary deformities. A total of 52 patients, comprising 38 males and 14 females with a mean age of 21.0 years (range: 16–42 years), who underwent secondary bilateral cleft lip repair operation via the J-shaped scar tissue flap technique in our clinic between 2014 and 2019 were included. Postoperatively, patients were followed up for an average of 2 years (range, 6 months to 5 years) to assess the outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry, based on the Global Aesthetic Improvement Scale (GAIS), patient-reported outcomes, and independent plastic surgeons' examinations. After an average follow-up of 2 years, outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry were successful, and none of the patients experienced new notch formation, muscular functional loss, lip volume loss, or asymmetry. Owing to good muscular function preventing the stretching, the postoperative scars become more acceptable to the patients. The technique has proven to be safe and successful through the GAIS objective assessment, as also confirmed by the examinations of the three independent surgeons, while the majority of patients reported an exceptional improvement in the appearance alongside a more than 95% satisfaction rate with the operation. In conclusion, our findings revealed successful functional and aesthetic outcome of using J-shaped scar tissue flaps in secondary repair of cleft lips. The technique was associated not only with the correction of significant secondary deformities yielding an improved and symmetrical lip volume, correction of vermilion notch, and prevention of notch re-formation but also with the restoration of orbicularis oris muscle function and thus integrity of the lip with minimal scarring.



Publication History

Article published online:
10 January 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Zhang JX, Arneja JS. Evidence-based medicine: the bilateral cleft lip repair. Plast Reconstr Surg 2017; 140 (01) 152e-165e
  • 2 Taub PJ, Piccolo P. Cleft lip repair: through the looking glass. J Craniofac Surg 2016; 27 (08) 2031-2035
  • 3 Naidoo S, Bütow KW. Philtrum reconstruction in unilateral cleft lip repair. Int J Oral Maxillofac Implants 2019; 48 (06) 716-719
  • 4 Nadjmi N, Amadori S, Van de Casteele E. Secondary cleft lip reconstruction and the use of pedicled, deepithelialized scar tissue. Plast Reconstr Surg Glob Open 2016; 4 (10) e1061
  • 5 van Schijndel O, Litschel R, Maal TJ, Bergé SJ, Tasman AJ. Eye tracker based study: perception of faces with a cleft lip and nose deformity. J Craniomaxillofac Surg 2015; 43 (08) 1620-1625
  • 6 He J, Xu H, Wang T. et al. Simultaneous reconstruction of columella and philtrum using prolabial flap combined with Abbe flap in secondary bilateral cleft lip and nasal deformity. J Craniomaxillofac Surg 2018; 46 (01) 1-5
  • 7 Baek RM, Myung Y, Park I. et al. A new all-purpose bilateral cleft lip repair: Bilateral cheiloplasty suitable for most conditions. J Plast Reconstr Aesthet Surg 2018; 71 (04) 537-545
  • 8 Song T, Yin N, Li H, Zhao Z, Zhao M, Huang J. Bilobed mucosal flap for correction of secondary lip deformities following cleft lip surgery. J Plast Reconstr Aesthet Surg 2011; 64 (05) 589-594
  • 9 Matsuo K, Fujiwara T, Hayashi R, Ishigaki Y, Hirose T. Bilateral lateral vermilion border transposition flaps to correct the “whistling lip” deformity. Plast Reconstr Surg 1993; 91 (05) 930-935
  • 10 Cohen SR, Kawamoto Jr HK. The free tongue graft for correction of secondary deformities of the vermilion in patients with cleft lip. Plast Reconstr Surg 1991; 88 (04) 613-619
  • 11 Ahuja RB. Vermilion reconstruction with labia minora graft. Plast Reconstr Surg 1993; 92 (07) 1418-1419
  • 12 Chen PK, Noordhoff MS, Chen YR, Bendor-Samuel R. Augmentation of the free border of the lip in cleft lip patients using temporoparietal fascia. Plast Reconstr Surg 1995; 95 (05) 781-788 , discussion 789
  • 13 Niechajev I. Lip enhancement: surgical alternatives and histologic aspects. Plast Reconstr Surg 2000; 105 (03) 1173-1183 , discussion 1184–1187
  • 14 Ersek RA. Transplantation of purified autologous fat: a 3-year follow-up is disappointing. Plast Reconstr Surg 1991; 87 (02) 219-227 , discussion 228
  • 15 Patel IA, Hall PN. Free dermis-fat graft to correct the whistle deformity in patients with cleft lip. Br J Plast Surg 2004; 57 (02) 160-164
  • 16 Kawamoto Jr HK. Correction of major defects of the vermilion with a cross-lip vermilion flap. Plast Reconstr Surg 1979; 64 (03) 315-318
  • 17 Zhao Z, Li Y, Xiao S. et al. Innervated buccal musculomucosal flap for wider vermilion and orbicularis oris muscle reconstruction. Plast Reconstr Surg 2005; 116 (03) 846-852
  • 18 Millard DR. Extensions of the rotation-advancement principle for wide unilateral cleft lips. Plast Reconstr Surg 1968; 42 (06) 535-544
  • 19 Mitsukawa N, Hosaka Y. Secondary correction of deformities of the vermilion with exposed oral mucosa after cleft lip repair. J Craniofac Surg 2008; 19 (05) 1370-1373
  • 20 Park BY, Roh TS. Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity. Plast Reconstr Surg 1999; 104 (07) 1976-1981
  • 21 Wakami S, Harada T, Muraoka M, Ishii M. Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips. J Plast Reconstr Aesthet Surg 2010; 63 (01) 22-27
  • 22 Nicolau PJ. The orbicularis oris muscle: a functional approach to its repair in the cleft lip. Br J Plast Surg 1983; 36 (02) 141-153
  • 23 Lim AA, Allam KA, Taneja R, Kawamoto HK. Constructing the philtral column in the secondary cleft lip deformity: utilizing the palmaris longus graft. Ann Plast Surg 2013; 70 (03) 296-300
  • 24 Mulliken JB, Wu JK, Padwa BL. Repair of bilateral cleft lip: review, revisions, and reflections. J Craniofac Surg 2003; 14 (05) 609-620
  • 25 Choi WY, Yang JY, Kim GB, Han YJ. Surgical correction of whistle deformity using cross-muscle flap in secondary cleft lip. Arch Plast Surg 2012; 39 (05) 470-476
  • 26 Erol OO, Pence M, Agaoglu G. The Abbé island flap for the reconstruction of severe secondary cleft lip deformities. J Craniofac Surg 2007; 18 (04) 766-772
  • 27 Yin NB, Gao F, Wang YQ, Song T, Li HD. Correction of secondary bilateral complete cleft lip and whistling deformities: the advance and rearrangement of the bilateral lip tissues. Aesthetic Plast Surg 2011; 35 (05) 750-755
  • 28 Grewal NS, Kawamoto HK, Kumar AR, Correa B, Desrosiers III AE, Bradley JP. Correction of secondary cleft lip deformity: the whistle flap procedure. Plast Reconstr Surg 2009; 124 (05) 1590-1598
  • 29 Black PW, Scheflan M. Bilateral cleft lip repair: “putting it all together”. Ann Plast Surg 1984; 12 (02) 118-127