Nagpur technique (triple wedge technique) for cleft lip repair in the first plastic surgery department of India: Principle and its evolution

Abstract

ABSTRACT Background: Cleft lip chelioplasty can be approached with a wide array of different techniques. The ultimate goal of all techniques is to restore sphincter competence and aesthetically favorable outcome. Dr.C. Balakrishnan of Government medical college,Nagpur devised an original triple wedge technique,a form of three triangular flap,that was evolved independently of the triangular flap technique. Unfortunately he did not publish his technique,even today many of his 4th and 5th generation trainees perform triple wedge technique for cleft lip repair.[1-3] The history of cleft lip repair in Nagpur and it’s growth can not be dissociated from modern plastic surgery in India by the father of modern plastic surgery in India Dr. C.Balakrishnan himself,who established the first department of plastic surgery in India at GMC Nagpur,credited it with a new classification of cleft lip and palate, a new technique of cleft lip repair and propagated the principles of comprehensive cleft care. In our institute triple wedge repair for cleft lip is the repair of choice since 1950, although many modifications have been done in original technique since then. I was trained in KEM hospital,Mumbai and learned Millard’s repair there. After coming to Nagpur,I joined the department as lecturer under respected Dr S.M. Kale sir and I got the opportunity to learn triple wedge technique from him. Over the last 20 years I have added few modifications like changing the orientation of triangles,using the mucosal element for anterior palate repair which used to be discarded in original triple wedge technique and primary rhinoplasty. Aims and Objectives: In this original article we are describing the original triple wedge technique invented by father of modern plastic surgery in India Dr.C. Balakrishnan 2 and its evolution since then in the first department of plastic surgery in India. Materials and Methods: Patients operated in last 50 years at Government Medical college,Nagpur and data available in department. Results: Early and late postoperative pictures showing result of the technique. Conclusion: The purpose of this article is illuminating unpublished work of legend of plastic surgery in India Dr. C. Balakrishnan.