Domino Flaps for Repairing of Secondary Bilateral Cleft Lip With Severe Columella Deformity

The patients with secondary bilateral cleft lip and nasal deformity always suffer from a serious part of the horizontal and vertical soft tissue deficiencies in the upper lip and nose, especially the columella. Normally, the Abbe flap is used to increase the soft tissue volume of upper lip. However, how to reconstruct the sever columella deficient, how to make full use of the Abbe flap and the remaining soft tissue of the upper lip, are always the problems that need to be solved by plastic surgeons. Twenty-nine patients with secondary bilateral cleft lip and severe columella deficiency were simultaneously reconstructed with several local flaps like dominos that was called "Domino sliding flaps." Six of the patients had their nasal tip and dorsum or collumella augmented and modified with autologous costal cartilage at the same time. The other 23 patients underwent the autologous auricular cartilage augmentation. The patients were followed from 15 months to 50 months. No secondary deformation occurred in any of the patients. 93.1% patients were satisfied with the aesthetics postoperatively, 89.7% patients were satisfied with the incision and donor site scar. Among them, 3 of the patients got hypertrophic scar on the upper lip and were modified 1 year after their first operations. The operational technique of the domino sliding flaps could better play the role of the Abbe flap. It also gave plastic surgeons an effective method to modify the severe deformities of bilateral cleft lip in 1 stage.