title: White Roll Vermilion turn down flap in primary unilateral cleft lip repair: A novel approach.
abstract: OBJECTIVE
  Numerous modifications of Millard's technique of rotation - advancement repair have been described in literature. This article envisions a new modification in Millard's technique of primary unilateral chieloplasty.
  
  
  METHODS
  Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard's repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion.
  
  
  RESULTS
  With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid's bow with no vermilion notching of the lips.
  
  
  CONCLUSIONS
  WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.
authors.affiliation: Department of Plastic Surgery, Sushrut Institute of Plastic Surgery, Lucknow, Uttar Pradesh, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Mishra
authors.affiliation: Department of Plastic Surgery, Sushrut Institute of Plastic Surgery, Lucknow, Uttar Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
keywords: Primary cleft lip repair; Unilateral chieloplasty; WRV flap; embryological cleft lip repair; modified Millard's repair; secondary cleft lip deformity; turn down flap; whistle deformity