Simultaneous correction of scars and tissue deficiency with composite grafts in secondary cleft lip deformity

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.

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.

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.

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.