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Z-Plasty Technique Using a Large C-Flap to Maximize Symmetry of Cupid's Bow and Minimize Scar in Unilateral Cleft Lip Repair
Sanjay Naran, Renata Maricevich, MD, Liliana Camison, MD, Catherine Garland, MD, Lorelei J. Grunwaldt, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: Gaining symmetry of Cupid's bow is challenging in cleft lip repair; especially when the difference between the distance from the peak of Cupid's bow on the non-clefted side to the collumelar labial junction and the new peak of Cupid's bow on the clefted side to the collumelar labial junction is great. A technique is described which uses a rotation type flap with a modification to gain maximum length and minimal scar.
METHODS: A retrospective review of unilateral cleft lip repairs performed by a single surgeon from 2010-2014 was performed. Patients with at >6 months of follow-up were included. Pre-operative, intra-operative, and post-operative photographs were reviewed. Repair utilized a Z-Plasty type rotation flap with a very large C-flap. Post-operative photographs were analyzed for symmetry of Cupid's bow and scar appearance.
RESULTS: 30 patients were evaluated (13 complete, 17 incomplete clefts); 18 male and 12 female; 11 right-sided and 19 left-sided clefts. 7 were excluded because of inadequate follow-up. 23 were analyzed. 86% had excellent symmetry of Cupid's bow (level). 1 had a slightly long Cupid's bow, and 2 had a slightly short Cupid's bow. 78% had an excellent scar (nearly imperceptible) and 22% had a good scar (slightly visible).
CONCLUSIONS: Z-Plasty with a very large C-flap is a useful technique for leveling Cupid's bow and attaining excellent scars that are nearly imperceptible. Further work will look at severity of the pre-operative cleft as measured by visual analogue scale and will compare this to post-operative appearance of the lip (symmetry of Cupid's bow and scar).


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