Review of two cutaneous closure methods for Tessier 7 repair: Straight-line versus Z-plasty

Aim of the Study: The aim of this study is to retrospectively analyze the surgical outcomes of patients who were treated for Tessier 7 cleft deformity, over a period of 10 years and compare the two cutaneous closure methods used for the treatment of the same in our cleft center. Patients and Methods: This is a retrospective audit of all the patients who had undergone Tessier 7 cleft repair from 2010 to 2020 in our center. Relevant details from recorded case histories were extracted and the surgical technique (Straight-line closure or Z-plasty technique) used for the closure of each case was analyzed. The benefits and drawbacks of linear closure and geometric closure methods were also studied. The preoperative, postoperative, and follow-up records and photographs were assessed for the results. Results: Of the 40 patients, 23 patients had skin closure done using Z-plasty technique while 17 patients had the closure done using the straight-line method. The average age at repair was 10.6 months and the follow-up period was unto 1.5 years. Visual Analog Scale and Scar assessment scales revealed Z-plasty skin closure scars were more conspicuous than straight-line closure ones. Lateral migration of the commissure was not an evident finding. Conclusion: Z-plasty or W-plasty can be avoided in repair of transverse facial clefts. Closure of the orbicularis oris muscle is the critical step to provide a counterforce to the contraction of the cutaneous scar and no lateral migration or hypertrophic scarring is present after straight-line cutaneous closure.