Upper Triangular Flap in Unilateral Cleft Lip Repair

Abstract

In this article, the authors describe their use of the upper triangular flap method to repair unilateral cleft lips in 250 patients with cosmetically appealing and predictable results. This method produces a straight philtral column scar that is parallel to the noncleft side and hides the surgical scars on the medial aspect of the nostril and in the lip-columellar crease. The first step is to assign the reference points along the vermilion border and the nostril sills. It is important to identify the nostril sill on the cleft nose, which could be particularly attenuated in wide clefts. Next, the upper triangular flap is designed on the upper part of the cleft side, having made allowance for the sillo-columellar distance. The dissections are performed along the drawn line joining functional points. The repair begins from the floor of the nostril, where the "neo-sill" is sutured directly opposite to the noncleft sill. The sillo-columellar distance (s-c) must be reestablished and the small triangular flap is not dissected into 3 layers to avoid devitalizing the skin. The muscle layers are identified, approximated, and held on stay sutures, which are tied in sequence. In this work, the authors identify the apparent lip length and the real lip length. It must be noted that the correction for shortening of the cleft philtral column is done on the real lip length by all other methods used for unilateral cleft lip repair, including our upper triangular flap method. On the basis of its simplicity and their postoperative results, the authors believe this approach offers further insight into cleft lip repair.

Nasal sill augmentation: an overlooked concept in rhinoplasty—a technical note and review of the literatures

“… UCL Flap repositioning following dissecting depressor septi and the medial orbicularis oris muscles 378 AB (along the scar line) 12 months Stable and natural form of the nostrils and nasal sill NCR [ 13 ] UCL Use of Millard method for correction of the upper part of the lip Elevation of superiorly based scar flap Creation of soft tissue pocket in the nostril floor Folding and insertion of scar flap into the pocket Flap securing with a pull-out stich 16 AB (along the scar line) Up to 4 years Acceptable esthetic outcomes Long lip Drooping of the cleft side Pyriform gap [ 3 ] UCL Double Composite Tissue Z-plasty using ilium, rib or costicartilage graft if necessary 68 AB (along the scar line) 14.6 months Symmetric width of the nostrils and nasal sill and correction of septum and columella deviation 2 graft deviation, 4 impaired ventilation, 1 decreased nostril size No complications such as bleeding, infection, flap necrosis, and sensory dysfunction [ 10 ] UCL Triangular flap with pedicle on the nasal base transferred medially to reconstruct the nostril sill 9 AB (along the scar line) No follow-up was reported Elevation of the sill area was reported, satisfactory results by the patients. NCR [ 14 ] UCL Elevation and subsequent overlapping of medial and lateral orbicularis oris muscle flaps through an intraoral incision without using filling materials; a tight, large-bite suturing of the muscle in the alar base to correct the sill depression 60 AB (along the scar line) 20 months (Mean) Effective nostril sill Augmenting without graft, minimal scarring NCR [ 15 ] UCL Upper triangular flap Reestablishing of the sillo–columellar distance muscle layers approximation 250 AB (along the scar line) 2 years for 40% of patients Straight philtral column scar parallel to the noncleft side to hide the surgical scars on the medial aspect of the nostril and in the lip-columellar crease NCR [ 16 ] ...…”