The repair of cleft lip is one of the most common treatments in plastic and maxillofacial surgery clinics. In order to utilize the affected tissue more effectively and to correct the lip and nose deformity to the maximum extent, surgeons from various countries have designed various surgical procedures over the years, including some creative surgical approaches that are considered to be plastic surgery art. However, up to now, there is no procedure that can guarantee that while repairing the normal upper lip, including the shape of the midperson, sufficient tissue volume can be obtained to repair the shape of the nasal tip and the nasal floor, while ensuring adequate descent of the affected lip peak. For this reason, we have designed a surgical approach different from previous cleft lip repair, aiming to reduce intraoperative tissue loss even more, to lower the affected lip peak more effectively, and to make the surgical scar more consistent with the shape of the midpersonal ridge, while facilitating the lifting of the nasal tip and shaping the nasal base.
To date, the white-lip triangular flap procedure, represented by the Tenneson-Randoll’s procedure, has been gradually abandoned by surgeons because of the disruption of the affected midpersonal crest and the additional incisional scar below the white lip, which is considered to be one of the causes of the development of the anterior alveolar ridge. The Millard’s technique is the most commonly used in traditional cleft lip repair. Later on, various techniques such as Mohler’s and Noordhoff’s can be interpreted as variants of this technique, the basic principle of which is to lower the labial peak by rotational advancement, but the difference lies in the design and utilization of the c-flap. The rotational advancement approach has obvious advantages, as this type of surgery avoids additional incisions in the lower part of the white lip, making the human middle on the affected side a more natural step, and the application of the c-flap is more conducive to the composition of the nasal base, and in some procedures even to the lifting of the nasal tip. However, the rotational advancement method is not perfect when applied clinically, because the formation of the nasal base on the affected side relies on the suture of the affected intrinsic nasal base tissue with the C-flap, which will inevitably form a scar perpendicular to the lower edge of the nasal base in the middle or medial part of the nasal base. In addition, since the scar is often an arc from the base of the triangular flap below the nasal minors to the peak of the affected lip after the incision is closed, although the direct destruction of the affected midpersonal ridge is avoided, it results in asymmetry of the midpersonal ridge on both sides. On the other hand, how to adequately lower the affected labial peak has always been a more difficult problem for the rotational advancement method. In cases with a large difference in bilateral lip height, it is difficult to achieve adequate lowering of the labial peak simply by rotating the tissue flap, and the triangular flap under the white lip is often unavoidable, making the advantages of the rotational advancement method greatly reduced.
At the same time, correction of nasal deformity in stage I cleft lip surgery has been a difficult problem. Previous approaches relied more on the anatomical and repositioning fixation of the cartilage, followed by postoperative suspension of sutures and long-term silicone mold support. Despite the strenuous efforts of physicians and patients, the long-term results are still unsatisfactory. Many patients have recurrence of nasal deformity, leaving nasal wing abduction and collapse, nasal tip twisting and sagging, and transverse nostril morphology, which increases the difficulty of second-stage surgery.
For this reason, we designed a new surgical approach by designing a trilobed flap in the healthy white lip region. Since the trilobed flap provides the amount of tissue needed to repair different anatomical regions, the clinical cleft lip repair is done separately in three regions: nasal tip, nasal floor, and lip. The upper flap A is rotated toward the lateral aspect of the nasal column to repair the tissue defect next to the nasal column after tip elevation and to facilitate the shaping of the affected nostril and nasal wing and the maintenance of the tip elevation effect; the middle flap B is rotated toward the nasal base to avoid scarring perpendicular to the lower edge of the nose and to reconstruct the structure of the nasal base area to form the ideal appearance of the nasal dike; the remaining lower flap is advanced directly toward the affected side without rotation and is sutured directly with the affected The remaining lower flap is advanced directly to the affected side without rotation and is sutured directly with the affected flap, which fully descends the labial peak and restores the shape of the affected midpersonal ridge while making the incision scar form a straight-like line corresponding to the healthy midpersonal area. Since the problem of blood flow at the tip of the flap in the tension area is avoided, the flap is completely viable after surgery, and no epidermal erosion is even seen. This procedure avoids many defects of the traditional procedure and has the advantages of simple and reliable flap design, which can be accurately mastered by beginners.
The disadvantages of this procedure are two: 1. In wider cases, theoretically, the upper lip may have more tension in the middle part. However, no practical difficulties were encountered in the clinical operation because the process of returning the flap to its normal position on the healthy side compensated for this drawback to some extent.
2, In the case of more extreme narrowing of the development of the healthy side of the human middle, mild torsion of the human middle can occur after suturing, and this should be noted during flap design.