Preserving aesthetic units in cleft lip repair.

Techniques for cleft lip reconstruction continue to evolve as plastic surgeons strive to achieve the most natural lip and nasal configuration. Critical analysis of cleft lip repairs led to the development of the ipsilateral columellar Z-plasty. Since 1988, 120 infants have undergone this procedure as their primary cleft lip repair. The philtrum is designed as a symmetric aesthetic unit extending into the columella as needed. The entire tissue deficiency is then reflected in the columella. The defect is filled by an ipsilateral flap which is designed as an asymmetric Z-plasty with the resultant transverse limb at the junction of the lip and columella. The abnormally oriented muscle is extensively dissected and reconstructed as a separate layer. The nasal deformity is reconstructed by elevating and rotating the displaced alar cartilage and controlling the dead space with bolsters or nasal conformers. This method suggests a way of rearranging the medial segment tissue to achieve adequate columellar length and a symmetric philtrum, with the cutaneous scar, the mirror image of the philtral column on the non-cleft side. The lateral tissue remains lateral with less mucosal attenuation and tightening.