Reddy Gosla Srinivas, Webb Roger M, Reddy Rajgopal R, Reddy Likith V, Thomas Peter, Markus A F
Hyderabad, India; Poole, United Kingdom; and Cincinnati, Ohio From the GSR Institute of Craniofacial Surgery; the South Coast Higher Surgical Training Program in Maxillofacial Surgery; the Division of Oral and Maxillofacial Surgery, University of Cincinnati; Dorset Research and Development Support Unit, Bournemouth University; and Dorset Cleft Center.
Plast Reconstr Surg. 2008 Mar;121(3):932-940. doi: 10.1097/01.prs.0000299282.63111.3f.
No one technique of cleft lip repair consistently produces ideal aesthetic and functional results. This study was carried out in a developing, high-volume center. It compares outcomes attained using two different designs of skin incision used for primary closure of unilateral complete cleft lip and sought to identify the most appropriate technique for clefts of varying morphology.
Seven hundred ninety-six patients were entered into the study. In each group of slightly less than 400 patients, either a modified Millard or Pfeifer wavy line incision was used, both in conjunction with functional repair of the underlying tissues as described by Delaire. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid's bow, lip length, and nostril symmetry and appearance of the alar dome and base.
Comparison of the two cohorts using Pearson chi-square testing for association and linear trend found a Millard incision gave significantly better results for vermilion match, whereas the Pfeifer method led to a better postoperative lip length. Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically.
Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another, but in this study, it was found that one technique was essentially as good as the other. This suggests that the technique for closure of the underlying tissues is probably of more importance.
没有一种唇裂修复技术能始终如一地产生理想的美学和功能效果。本研究在一个发展中的、高手术量的中心进行。它比较了用于单侧完全性唇裂一期缝合的两种不同皮肤切口设计所取得的结果，并试图确定针对不同形态唇裂的最合适技术。
796例患者纳入本研究。在每组略少于400例患者中，分别使用改良的米勒德切口或法伊弗波浪线切口，均结合德莱尔所描述的对深层组织的功能性修复。术前记录唇部和鼻部的软组织测量数据。分析基于术后对白色卷边、唇红缘、瘢痕、丘比特弓、唇长、鼻孔对称性以及鼻翼穹窿和基部外观的评估。
使用Pearson卡方检验进行关联性和线性趋势分析比较两组队列，发现米勒德切口在唇红匹配方面效果显著更好，而法伊弗方法术后唇长更佳。一种特定技术更适合某些术前唇裂解剖形态的先入之见未得到统计学证实。
某些术前解剖特征可能会使外科医生优先选择一种特定的切口模式而非另一种，但在本研究中发现，一种技术本质上与另一种一样好。这表明深层组织的缝合技术可能更为重要。
