Designing The Prolabial Flap In Revisional Bilateral Cleft Lip Surgery: Clinical And Quantitative Analysis Of Post-operative Stretch With Longer-term Follow-up
jeffrey goldstein, MD1, Alina Sinha, MD2.
1Children's Mercy Hospital, kansas city, MO, USA, 2Children's Mercy Hospital, Kansas City, MO, USA.
PURPOSE: A hallmark of primary bilateral cleft lip repair is the emphasis on a narrow prolabial segment. Yet no data exists on the growth and stretch of the prolabial segment after a total secondary bilateral cleft lip revision. This information is critical to design. The aim of this study is to present a consecutive series of patients who underwent secondary bilateral cleft lip revision and quantify/characterize the post-operative prolabial changes with follow-up of at least 2 years.
METHODS: 19 consecutive patients were identified retrospectively. All patients were examined, measured, and photographed preoperatively, intraoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year, and then yearly. Measurements of prolabial width were made cephalically and caudally. Chart review and data acquisition was achieved.
RESULTS: The age at time of revision ranged from 4 to 18 years (mean 10). Of the 19patients, 4 were syndromic. The indication for revision were overwhelmingly whistle-tip deformities. From immediately postoperative to 1 month postoperative, the prolabium widened 20% cephalically and 23% caudally. From immediately postoperative to 3 months postoperative, the prolabium widened 35% cephalically/37% caudally. At 6 months postoperative, the widening was 44% cephalically/44% caudally. At 12 months postoperative, the prolabial widening was 40% cephalically/41% caudally. At 2 years postoperative, the prolabial widening was 41% cephalically/48% caudally.
CONCLUSIONS: In secondary bilateral cleft lip revision, the prolabial segment stretches significantly in the first 6 months postoperatively and then stabilizes. As in primary repair, this widening should be considered when designing a revisional prolabial flap.
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