title: Correction of secondary cleft lip deformity: the whistle flap procedure.
abstract: BACKGROUND
  The Kapetansky flap was described to repair a whistle deformity or central vermilion defect following a primary bilateral cleft lip repair. The authors studied a modification of this technique, called the Whistle (wide-hinged island swing transposition labial enhancement) flap, to correct a wide array of secondary cleft lip deformities.
  
  
  METHODS
  Patients with secondary cleft lip deformity who underwent the Whistle flap correction were studied (n = 21). Vertical lip height, lateral lip projections, and three-dimensional volumetric measurements were recorded along with physician and parent-patient satisfaction surveys.
  
  
  RESULTS
  From 1994 to 2006, 23 Whistle flap procedures were performed on 21 cleft lip patients (bilateral, n = 13; unilateral, n = 8). The average age at surgery was 15.4 years (range, 13 to 21 years). The average follow-up was 27.6 months. The vertical height of the cleft side Cupid's bow to vermilion bottom had a mean increase of 164 percent. Lateral projection of the upper lip showed a mean increase of 117 percent. Preoperatively, patients exhibited mean volumetric asymmetry of 29.4 percent, and this was reduced following treatment to approximately 3.1 percent. Physician satisfaction using a modified Whitaker classification (categories I through IV) demonstrated that 56 percent of patients were category I (no refinements necessary) and 44 percent were category II (minor revisions are advisable). Parent-patient satisfaction in the follow-up period was a mean of 3.5 as measured using a five-point scale ranging from 0 to 4. There were minimal perioperative complications.
  
  
  CONCLUSIONS
  The Whistle flap procedure provided a versatile and reliable option for the correction of vermilion defects from secondary cleft lip deformities.
authors.affiliation: Los Angeles, Calif. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
authors.forename: Navanjun S
authors.initials: NS
authors.lastname: Grewal
authors.forename: Henry K
authors.initials: HK
authors.lastname: Kawamoto
authors.forename: Anand R
authors.initials: AR
authors.lastname: Kumar
authors.forename: Bryan
authors.initials: B
authors.lastname: Correa
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Desrosiers
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D002971:Cleft Lip / Q000473:pathology* / Q000601:surgery*; D005152:Facial Muscles / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult