Straight-line closure: a preliminary to Millard closure in unilateral cleft lips (with a history of the straight-line closure, including the Mirault misunderstanding).

We have completed 25 SLC-RAC sequences for complete unilateral clefts of the lip, using the straight-line closure as a preliminary step to facilitate the definitive closure, which is done about 6 months later. Fourteen of the straight-line closures were done on newborn children with local anesthesia, and the rest were done at a later time under general anesthesia because of later referral or refuge/immigrant status, using general anesthesia. We have had no major complications such as lip dehiscence, major infection, respiratory problems, or bleeding. Since our original publication, we have increased the scope of the straight-line closure to include wider nasal undermining for better repositioning of the nasal structures, and we have adopted Millard's technique of lining the gap in the pyriform aperture with a vermilion flap (Millard's "L" flap). Our oldest patient is not yet in adolescence, so our study is incomplete, but our impression is that the preliminary straight-line closure has materially improved the results of surgery for complete unilateral cleft lips. The history of the straight-line closure forms a continuum from the 1st century A.D., and includes Malgaigne, Mirault, and Veau repairs as well as those of many others.