Simultaneous correction of scars and tissue deficiency with composite grafts in secondary cleft lip deformity.
OBJECTIVE
In secondary cleft lip deformities, repetitive surgeries lead to increased tension and deformities in the upper lip, ultimately resulting in new deformities such as wide scars and a tight lip. The simultaneous correction of a wide scar and tissue deficiency in the upper lip is paradoxical unless sufficient tissue is supplied to the scant upper lip. The authors describe a method to transfer composite tissue for the improvement of secondary cleft lip deformities and present an analysis of the outcomes.


METHODS
Ninety-one patients with secondary cleft lip, a wide scar, and tight lip were enrolled. After complete excision of the scar, the defect was covered with a composite graft that included skin and subcutaneous fat. The results were rated by 2 investigators blinded to the image of the scar and the morphology of the upper lip. The skin color of the 25 grafts was analyzed using a narrowband spectrophotometer using the Commission International d'Eclairage L*a*b* color coordinates.


RESULTS
All grafts survived without sequelae. The scores of the scar images and general morphology were 8.3/10 and 8.2/10, respectively. Spectrophotometric analysis displayed no differences between the composite tissues and normal upper lip skin in each color coordinate, indicating that the composite tissue had a good color match with a normal upper lip.


CONCLUSIONS
The use of a composite graft on the upper lip can be a reliable option to correct a wide hypertrophic scar and tight lip simultaneously, resulting in a satisfactory scar image and an improvement of upper lip morphology.
Institute of Human Tissue Restoration, Department of Plastic Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Korea.
Dong Won
DW
Lee
Young Seok
YS
Kim
Be-young Yun
BY
Park
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology / Q000601:surgery*; D017439:Cicatrix, Hypertrophic / Q000601:surgery; D002971:Cleft Lip / Q000601:surgery*; D003116:Color; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008046:Lip / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012880:Skin Pigmentation / Q000502:physiology; D016038:Skin Transplantation / Q000379:methods*; D013053:Spectrophotometry / Q000379:methods; D050151:Subcutaneous Fat / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult