Upper Triangular Flap in Unilateral Cleft Lip Repair.

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.