Revisiting the Boot Flap for Secondary Repair of the Free Border in Cleft Lip.

Background: Deficiency of the free border of the lip and "whistling lip" deformity are encountered in secondary repairs of unilateral and bilateral cleft lip. We have reported the use of the de-epithelialized oral vestibular flap (boot flap) for secondary cleft lip repair. We experienced more cases using this method and analyzed them.

Methods: Fifty-nine patients with a cleft lip underwent secondary repair using this method. In unilateral cases, total scores were determined by evaluating the height of the notch, the volume of the upper lip tubercle, and the upper lip volume of the cleft side. In bilateral cases, total scores were determined by evaluating the height of the notch and the volume of the median lip tubercle.

Results: Of the 46 patients with a unilateral cleft lip, 3 patients underwent a second boot flap operation due to undercorrection, and 1 patient underwent boot flap revision. Of the 12 patients with a bilateral cleft lip, 1 patient underwent a second boot flap operation due to flap atrophy. The second operation could be performed without any difficulty in either unilateral or bilateral cases. Compared with the preoperative scores, the postoperative scores improved significantly in both unilateral and bilateral cases.

Conclusions: We experienced a recurrent notch deformity after direct suturing in a patient with a unilateral cleft lip. This was thought to be caused by scar contracture. To prevent a recurrent deformity, it is important to interrupt the plane where scar contracture occurs by incorporating a boot flap and augmenting the volume.