Detailed assessment of cleft lip scar following straight line repair

Minimizing upper lip skin scarring is one of the most important factors in cleft lip repair. Currently, Millard's procedure or one of its modifications is the most commonly used surgical repair procedure, yet several surgeons continue to prefer a more natural-looking straight scar. Some publications concerning the resultant scarring after Millard's procedure are available; on the other hand, those concerning that after straight line repair are limited. This study aimed to evaluate and analyse upper lip skin scarring following straight line repair in order to further refine our surgical procedure. Twenty-six patients with ages ranging from 4 years and 11 months to 6 years and 10 months (17 boys and nine girls) participated in this study. Each upper lip skin scar was divided into three portions and evaluated by three board-certified plastic surgeons who calculated the evaluation score. The score for each portion of the scar was analysed to determine the correlation of the score with the five following factors: type of cleft, age at operation, length of operation, skin texture regularity and skin brightness; the last two were determined using a facial-measurement instrument. Taking all the results into consideration together with practical experience, the quality of scars of the upper lip skin was thought to be correlated with the skin brightness and length of the operation, particularly in the case of the upper and middle third portions of the upper lip. In the lower third portion, the scar quality appeared to be more influenced by the age at operation. It is suggested that early surgical intervention may help minimize scarring because lip motion is weaker in younger babies than in older ones. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.