Reconstruction of vermilion deficiencies: The running V-flap technique

Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.

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“…36 However, excessive advancement can result in lip tightening that has been described as a blooming flower or fishlike puckering. 37…”

Section: Tissue Malpositionmentioning

confidence: 99%

Revisional Techniques for Secondary Cleft Lip Deformities

et al. 2021

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“…There were no color mismatches or scarring over the lip mucosa in all patients' mouths. 12 Our meta-analysis of the studies revealed that P=0.1641 and I2 (inconsistency) equal 44.67% so these studies showed no heterogeneity as regarding to the complication in whistling deformities Type of correction so we use total random effect and rate was 66 % with 95% CI of rate 0.00 -83.54 with absence of publication bias.…”

Section: Meta Analysismentioning

confidence: 81%

“…9 Furthermore, Grewal et al 10 reported that in the perioperative course, minimal complications occurred: wound breakdown (0 percent), bleeding (9 percent), infection (14 percent) that resolved after a course of oral antimicrobial, hypertrophic scarring (4 percent), functional lip difficulties during the first 6 weeks postoperatively (9 percent), or overall number of patients with any complications (21 percent). 10 Our meta-analysis for these studies showed that as P=0.0021* and I2 (inconsistency) equal 83.72% so these studies showed heterogeneity as regarding to patient's satisfaction in whistling deformities Type of Furthermore, Baser et al 12 performed a reconstruction of vermilion deficiencies using the running V-flap technique, they enrolled six patients (three female and three male) aged 16-42 years. Vermilion deficiencies in the upper lip were graded as grade I (n1), grade II (n3), grade III and grade IV.…”

Section: Meta Analysismentioning

confidence: 98%

Meta-analysis of secondary cleft lip deformities management

Metwally

Taha

Shalkamy

2022

Al-Azhar International Medical Journal

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“…Moreover, vermilion deficiencies in the upper lip were graded according to the classification system established by Jian et al This classification that introduced 4 categories is based on the degree of the upper incisive teeth and gum exposure. 14,15 According to this classification, grades III and IV were considered as severe whistle deformities. Clinically, the vermilion is divided into 2 distinct parts: wet and dry.…”

Section: Discussionmentioning

confidence: 99%