Reducing the vermilion notch in primary lip repairs: Z-plasty versus the Noordhoff triangular flap.

[OBJECTIVE] To compare Z-plasty and the Noordhoff flap for reducing notching in the vermilion during primary repair.

[STUDY DESIGN] Comparative study.

[PLACE AND DURATION OF STUDY] Plastic Surgery Department, Mayo Hospital, Lahore, from March 2008 to August 2010.

[METHODOLOGY] Patients presenting for primary unilateral cleft lip repair were included. The modified Millard's technique was used for lip repair. The percentage of the total vermilion thickness notched was recorded at 6 months follow-up. The repair was graded as: < 0.5 mm good, > 0.5 mm but < 1 mm satisfactory and > 1 mm poor. Patient satisfaction was rated on a scale of 1 to 10, with 10 being the happiest patient.

[RESULTS] In Group 1 (Z-plasty) 25 patients, and in Group 2 (Noordhoff flap), 20 patients achieved a good result. Five patients in Group 1 and 7 patients in Group 2 achieved a satisfactory result. Three patients in Group 2 had a poor result. Patient satisfaction and vermilion repair were comparable when comparison was made between the two groups (p > 0.05).

[CONCLUSION] The Noordhoff flap needs more expertise and finesse. All 3 poor results were achieved early in the study. Z-plasty was easier to execute and gave a good result in almost all hands.