Rotation Advancement Research Articles

Long-term Results of Unilateral Cleft Lip Repair With Multiple Infantile Hemangiomas Including the Cleft Side of the Upper Lip

PURPOSE: Cleft lip and infantile hemangioma are relatively common congenital diseases. However, infantile hemangiomas on the cleft side, in the operative field of cleft lip, are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had infantile hemangioma on the cleft side. We performed cleft lip repair on a patient with infantile hemangioma on the cleft side of the cleft lip at 3 months after birth and have been following-up on the patient for the past 18 years. We report the results of 18-year follow-up after the surgery of this rare patient. METHODS: The male patient was diagnosed with a left unilateral complete cleft lip with alveolar cleft and a submucous cleft palate. There were multiple infantile hemangiomas throughout his body, with no notable abnormalities in the chromosomal analysis. In particular, the patient had infantile hemangiomas on the upper lip and lower lip, right ear helix, back, and left shoulder. The hemangioma on the upper lip was on the lateral segment of the cleft side. As per the general treatment guidelines, cleft repair was performed at 3 months after birth. Millard’s rotation advancement technique was used for the repair, which uses the lower small triangular flap. The patient was followed up for 18 years after surgery. RESULTS: There was no excessive bleeding during the surgery, and blood transfusion was not needed. The excised tissue was confirmed to be infantile hemangioma in the histopathologic examination. The patient did not show any abnormalities during recovery, and there was some residue of infantile hemangioma in the repair site in the upper lip vermilion. The residual infantile hemangioma in the repair site of the upper lip vermilion was involuted by 5 years old, and there was only a normal degree of scarring after cleft lip repair of the upper lip vermilion. At the same time, the infantile hemangiomas in the right ear helix, back, and left shoulder were completely involuted without any scarring. The patient has been followed up until now, and at 18 years, he has no particular problems other than the red scar on the lower lip. CONCLUSION: Infantile hemangiomas requiring lip repair for unilateral complete cleft lip are extremely rare, and there are no established surgical guidelines for this condition. In such cases, delaying lip repair until the infantile hemangioma is involuted may not be desirable for obtaining the best esthetic outcome, and it is also not desirable because it may induce psychosocial impairment in patients and caregivers. Therefore, we believe that general cleft lip repair produces good outcomes even in cases involving hemangiomas on the cleft side.

Novel Technique to Repair Unilateral Cleft Lip: Separated Multiple Y-to-V-Plasty under Magnification.

BACKGROUNDVarious techniques have been used for cleft repair such as the straight-line closure, the rotation advancement technique and the anatomic subunit approach which are famous new approaches gained popularity. However, these methods have several advantages and disadvantages and sometimes are difficult to adopt. In this study, we described our novel technique, known as separated multiple Y-to-V-plasty, in treatment of several cases of unilateral cleft lip. METHODSPlastic surgeons usually try to avoid straight closure of the wound, especially in areas where they need to stretch, move and enhance the length of the wound in some stages of the procedure. Since the lip is a dynamic and active structure and is constantly moving, the use of straight-line incision and closure in that area is in conflict with this basic concept. RESULTSIn our newly introduced technique, we avoided a straight-line closure along the skin and mucosa for the repair of the unilateral cleft lip. This issue is of utmost importance in cases with severe loss of lip height and discrepancy. CONCLUSIONTo acquire a natural and balanced shape in unilateral cleft lip repair, we recommended the novel Y-to-V-plasty technique as an effective method for severe unilateral cleft lip with enormous discrepancy.

Mastopexy Autoaugmentation by Using Vertical and Triangular Flaps of Mammary Parenchyma Through a Vertical Ice Cream Cone-Shaped Approach.

Mastopexy autoaugmentation by using an extended vertical flap and two transverse triangular flaps of mammary parenchyma was performed through an adjustable vertical ice cream cone-shaped approach. A vertical rectangular flap with the length of the inferior pole and thickness of the mammary parenchyma was supported at the inframammary fold. Dissection of the vertical flap was extended underneath the areola until the projection of its upper limit, adding 4-5cm to the length of the vertical flap. A triangular flap supported on its lower half with 4-6cm long and thickness of the vertical pillar was dissected on both vertical pillars. Patients were followed up for 2years. The vertical rectangular flap filled the upper pole and central breast. The triangular flaps apart from filling the lower pole increased the mammary cone projection. The medial rotation advancement of the triangular flaps created a transverse support girdle at the lower pole, maintaining the vertical flap into position. In addition, fixation of the vertical flap along its entire length avoided long-term down-displacement of the breast. A keel resection of mammary parenchyma was performed in the larger breast in mild or moderate asymmetries. Mastopexy autoaugmentation through an adjustable vertical approach using vertical and triangular flaps of mammary parenchyma filled the upper pole and central breast and reshape the lower pole, recovering the breast contour. It provided long-term stabilization of the mammary cone without a breast implant or fat transfer. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Closure of an Oroantral Communication Using Leucocyte-Platelet Rich Fibrin: A Novel Technique Using Regenerative Medicine

Oroantral communication (OAC) is a common complication following extraction of maxillary posterior teeth because of the close anatomic proximity of the roots to the maxillary sinus. The most frequent methods described in the literature to close an oroantral communication involve buccal or palatal rotational advancement flap surgery or use of the buccal fat pad. These surgical procedures require advanced surgical skill and are associated with donor sit morbidity, such as avascular flap necrosis that can lead to soft tissue graft failure to close the OAC, infection and extreme postoperative patient discomfort that affects patient quality of life. This paper describes a novel technique using leucocyte platelet-rich fibrin matrix obtained from the patient’s own venous blood that leads to predictable soft tissue regeneration and closure of the OAC. This regenerative medicine procedure is clinician friendly, less traumatic compared to traditional methods of OAC closure with minimal postoperative recovery for the patient.
 

Imaging study of midface growth with bone-borne trans-sutural distraction osteogenesis therapy in growing cleft lip and palate patients

Trans-sutural distraction osteogenesis (TSDO) promotes midface growth in growing cleft lip and palate (CLP) patients with midfacial hypoplasia. The superficial skeletal changes after therapy revealed rotation advancement of the midfacial skeleton associated with differential displacement in each segment, but reports rarely focus on the changes of internal structures, including circummaxillary sutures, the maxillary tuberosity and the maxillary sinus, which may play a crucial role during this process. This study evaluated the computed tomographic (CT) images of 26 growing CLP patients who received bone-borne TSDO therapy. The results revealed that the most prominent new bone formation occurred in the pterygomaxillary suture and pushed the P-point forward. The maxillary first molar exhibited significantly greater advancement compared with the P-point due to the growth of the maxillary tuberosity. The contribution ratio values of the advancement of the maxillary tuberosity and P-point to the maxillary first molar were 26% and 74%, respectively, in UCLP and 25% and 75%, respectively, in BCLP. Furthermore, the maxillary sinus volume was also significantly increased. In conclusion, midface growth with bone-borne TSDO therapy depends on both secondary displacement promoted by sutural bone formation mainly in the pterygomaxillary suture and primary displacement by growth of the maxillary tuberosity and maxillary sinus volume.

Network high-performance grinding devices for ferromagnetic materials

The design features of the grinding devices that implement the impact destruction of the ferromagnetic materials particles in a magneto vibrating layer formed in a non-uniform magnetic field are considered. It is shown that when a magnetizable powder is affected by an alternating magnetic field with certain parameters, a magneto vibrating layer is formed, under the conditions of which, a random perturbing factor occurs. It is caused by the dipole particles clusters interactions and provides highefficient finish powder grinding. Methods for producing metal powders, which are distinguished according to the operating principle and to the requirements for the technological properties of the powders obtained, are analyzed. For coarse grinding, jaw, roller and cone crushers and mullers are used; at this, particles of 1-10 mm in size, which are the source material for fine grinding, are obtained. The finish grinding of the material obtained is carried out on the ball rotating, vibrating or planar centrifugal, vortex and hammer mills. The main drawback of these techniques of metal powder grinding is sticking of grinding body residue on the powder particles, which reduces the quality and operational properties of the powder. A relation to calculate the dependence of the fineness number of ferromagnetic materials on the induction gradient of an external variable magnetic field is proposed. The design features of an electromagnetic mill based on a screw drum that, due to the spatial orientation of its walls, ensures an effective movement of powder flows inside it, such as mixing, rotation, oncoming movement, translational motion and simultaneous advancement through the drum are presented. The concept and technological options of grinding powders in an electromagnetic mobile hammer mill are revealed, which enables to obtain a powder of a given particle size distribution with high uniformity. It is established that mills in which a magneto vibrating layer is implemented are more effective than mechanical ones: grinding of ferromagnetic powders in a magneto vibrating layer increases drastically the performance of the grinding process. Changing the parameters of the electromagnetic field, you can set an average particle size and the degree of homogeneity of the powder.

Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment.

ObjectivesThe outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments.Materials and MethodsThis was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues.ResultsOf the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups.ConclusionEssentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.

A High Fidelity Cleft Lip Simulator.

Cleft lip surgery is technically difficult requiring precise planning and understanding of 3-dimensional structures to obtain an optimal outcome. A physical cleft lip simulator was developed that allows trainees to gain experience in cleft lip repair and primary rhinoplasty before operating on real patients. A cleft lip simulator that comprises multilayered soft tissues, bone, and realistic dissection planes was developed using 3D printing, adhesive and polymer techniques. Four experienced cleft surgeons performed a total of 7 simulated repairs on the simulator. Feedback on the realism and value of the simulator was obtained from the surgeons. Six of the repairs were a Fisher anatomic subunit approximation technique, and 1 was a rotation advancement repair. All repairs were completed with successful performance of markings, incisions, dissections, and multilayered closure. All surgeons agreed that the simulator is realistic and that the simulator is a valuable tool for training in cleft lip surgery. A cleft lip simulator that allows performance of a cleft lip repair and primary rhinoplasty from start to finish was developed and pilot tested. The simulator provides a training platform to gain experience in cleft lip repair before operating on real patients.

A combined planning approach for improved functional and esthetic outcome of bimaxillary rotation advancement for treatment of obstructive sleep apnea using 3D biomechanical modeling

In recent years, bimaxillary rotation advancement (BRA) has become the method of choice for surgical treatment of obstructive sleep apnea (OSA). As dislocation of the jaw bones affects both, airways and facial contours, surgeons are facing the challenge of finding an optimal jaw position that allows for the reestablishment of normal airway ventilation and esthetic surgical outcome. Owing to the complexity of the facial anatomy and its mechanical behavior, individual planning of surgical OSA treatment under consideration of functional and esthetic aspects presents a challenge that surgeons typically approach in a non-quantitative manner using subjective evaluation and clinical experience. This paper describes a framework for individual planning of OSA treatment using bimaxillary rotation advancement, which relies on computational modeling of hard and soft tissue mechanics. The described framework for simulation of functional and esthetic post-surgery outcome was used in 10 OSA patients. Comparison of the simulation results with post-surgery data reveals that biomechanical simulation provides a reliable estimate for post-surgery facial tissue behavior and antero-posterior airway extension, but fails to accurately describe a surprisingly large lateral stretch of the velopharyngeal region. This discrepancy is traced back to anisotropic effects of pharyngeal muscles. Possible approaches to improving the accuracy of model predictions and defining sharp criteria for optimizing combined OSA planning are discussed.

Rotational Advancement in Cleft Nose Rhinoplasty – Buccal Mucosal Grafts Serve as a Powerful Tool

Our aim was to analyze our technique of a modified rotational advancement in conjunction with buccal mucosal grafts (BMGs) in a subgroup of severe cleft cases. A retrospective clinical and photographic evaluation was conducted. Columella angle (CA) and tip projection (TPR) served as instruments in a photometric analysis. Academic university hospital and specialized craniofacial cleft center. At the time of the secondary rhinoplasty, 61 cleft patients were included, all 17 years or older. Rotational advancement with usage of BMGs was performed in selected cases by a single surgeon. Nasal symmetry and aesthetic appearance. From 2003 to 2011, 29 unilateral severe cleft cases (group I) underwent a modified alar rotational advancement with BMGs. Group II, with 32 cases, represented patients without BMGs. Technique and management of BMGs were described in detail. The complication rate of donor and recipient site presented as very low. The CA was improved significantly in both groups. Also, TPR improved (not significantly) in group I. Using our technique, we considerably enhanced the aesthetic results and symmetry in secondary cleft rhinoplast. Rotating the vestibular skin makes it possible to eliminate the traction of this skin on the repositioned alar cartilage, therefore achieving a more pleasing and stable nasal symmetry in secondary cleft rhinoplasty. Versatile BMGs close this gap, thus making them a powerful tool in the arsenal of the reconstructive cleft surgeon.

Rotation advancement flap—a novel technique for breast conserving surgery in tumors of the upper lateral breast quadrant

Background: Focus on patient’s quality of life has dramatically changed the paradigm of surgical treatment of breast cancer. Contemporary breast surgery has to provide not only with good margins, but also with the best aesthetic result possible. Methods: A novel modification of an oncoplastic technique for breast tumors located in the upper-lateral quadrant is proposed and is based on two principles—flap rotation and advancement. Rotation advancement flap is a combination of wide rotation parenchymatous flap from the lateral part of the breast with a tissue complex from the axillary region. The point of rotation is the nipple-areolar complex (NAC). Results: Between 2013 and 2017, 33 procedures with the described technique were performed. The mean age of the patients was 49 years (range, 33–69 years), mean specimen weight 113.5 g (range, 36–268 g), tumor size—26 mm (range, 10–50 mm). Six patients (18.2%) received neoadjuvant chemotherapy. Sentinel lymph node biopsy (SLNB) was performed in 25 (75.8%) and axillary lymph node dissection (ALND) in 12 (36.4%) patients. Complications occurred in 7 (21.2%) patients: hematoma (n=2, including one revision), cellulitis (n=3, conservative treatment), and wound edge necrosis (n=2, revised). We followed up 32 (97%) patients during 29 (range, 6–48) months postoperatively. No loco-regional recurrence was registered, whereas distant metastases were revealed in 2 (6.1%) patients; 1 (3%) of the patients succumbed to breast cancer. Conclusions: We have proposed a novel technique of the rotation advancement flap in breast conserving surgery. This technique is reliable and allows for correcting potential deformities and significant volume loss. It may provide with an excellent aesthetic result and is considered a safe alternative to more complex operations.

Cervicofacial Rotation Advancement Flap in Cheek Reconstruction

Introduction: The Cervicofacial rotation advancement flap (CRAF) is a random-pattern flap that provides an excellent match for cheek reconstruction. In this report, the authors review their experience with this flap and present their advantages in order to expand the awareness and promote the application.Methods: A retrospective analysis of reconstruction of cheek defects using CRAF was performed in 12 patients. Data on patient demographics; diagnosis, defect type, and outcome were collected. Results: These patients included 07 male and 05 female; they ranged in age from 56 to 88 years, with a mean age of 67 years.05 patients used tobacco and one patient had a history of radiation. On histopathological examinations of the specimen, 03patients had squamous cell carcinoma, and 09 patients had basal cell carcinoma. The mean defect size was 40cm² [range 10 to 67cm²]. The mean follow-up was 06 months [0 to 24 months]. One patient was lost to follow-up after suture removal. As complication 01 patient had flap necrosis No facial nerve injury was observed. All patients were pleased with the outcome of the Cosmetic results. Conclusion: Cervicofacial flap provides a technically simple, reliable, safe, efficient, and cosmetic means to reconstruct defects of the cheek.

Innovation in the planning of V-Y rotation advancement flaps: A template for flap design.

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19–80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses

Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses

Reconstructive options for large back free flap donor sites.

Reconstruction of posterior thoracic and trunk defects can prove challenging even to the most seasoned surgeons. Many commonly used techniques for closing back defects include primary closure and split skin grafts. Often times, however, other techniques are needed in order to give the patient the best aesthetic and functional outcome. In this study, we focus on and evaluate donor site closure techniques for defects in the back created by harvesting scapular and parascapular flaps. Twenty patients were operated on to remove pathologically diagnosed sarcomas using a wide local excision. The defects, ranging from 5 to 22 cm in width, were closed using donor flaps from the scapular/parascapular region. Nine donor sites were then closed primarily with wide undermining, while 11 donor sites were closed using multiple techniques, such as large transposition flaps, large rotation advancement flaps, keystone neurovascular island flaps, latissimus dorsi advancement flap and large Y-V advancement flaps. All recipient and donor flaps survived with good aesthetic and functional outcome. Patient satisfaction was high and only two of 20 donor site flaps required further surgery due to wound dehiscence. No other complications were seen during the follow-up period. The proposed advanced techniques for donor site closure in back defects have shown that primary wound healing can be achieved with the use of a variety of different techniques and the avoidance of the complications of a skin graft.

Treatment of congenital clasped thumb in arthrogryposis.

IV.

The Modification of Rotation - Advancement Flap Made in 1950.

The early techniques of cleft lip repair involved the straight-line technique, the triangular flap technique or some kind of geometric line (triangular, quadrangular closure). A turning point in cleft lip surgery was in 1955 when doctor. Millard presented his method: the rotation-advancement technique or flap, at the First International Congress of Plastic Surgery in Stockholm. Today, the technique, with or without some modifications, is used by more than 85% of cleft surgeons around the world. We are presenting a patient with complete unilateral cleft lip and palate who underwent surgery sixty-five years ago. The scar on his lip was similar to rotation advancement line. Cheiloplasty was performed by Professor Šercer in 1950, five years before Millard's publication. Professor Ante Šercer was an internationally recognized Croatian scholar in the area of ear, nose and throat diseases. He also gave a significant contribution to surgical management of velopharyngeal insufficiency and plastic surgery of the nose and ear.

Segmental maxillomandibular rotational advancement in obstructive sleep apnoea: a long-term follow-up

Background: Maxillomandibular advancement (MMA) is a safe and highly effective treatment for obstructive sleep apnoea (OSA). MMA is one type of orthognathic surgery planned to maximise the forward movement of the maxillomandibular complex (MMC) and expand pharyngeal airway in OSA patients. Therefore, MMA may cause excessive maxillomandibular protrusion, especially on patients with thinner facial soft tissue. Objective: To prevent unfavourable facial aesthetics after MMA while maintaining the maximal advancement of MMC, the authors perform segmental maxillomandibular rotational advancement (SMMRA) as the modification technique of the MMA. Methods: SMMRA is combination with Le Fort I osteotomy, maxillary anterior segmental osteotomy to provide additive advancement of posterior maxilla using extracted premolar space and bilateral sagittal split osteotomy. MMC is undergoing counterclockwise rotation. Findings and Conclusions: A 33-year-old male patient suffered from sleep disorder was referred to our hospital. He had body mass index of 23 kg/m2 and mandibular retrognathism. Cephalometric X-ray showed mandibular retrusion and narrow pharyngeal airway. Polysomnography (PSG) indicated moderate OSA (apnoea–hypopnoea index [AHI] = 23/h; lowest SaO2 = 80%). SMMRA combination with trapezoid mortised genioplasty was performed. Postoperative cephalometric X-ray showed that ANB improved 13–3°. Pogonion was advanced by 20 mm. Middle and lower pharyngeal airway increased by 8 mm and 10 mm, respectively. Postoperative PSG indicated drastic improvements (AHI = 1.7/h; lowest SaO2 = 89%). Six-year follow-up will be presented. The patient's sleep condition, occlusion and aesthetic were stable 6 years after SMMRA. However further follow-up and management is recommended.

Changes in Nasal Configuration Following Primary Rhinoplasty: Direct Anthropometric Measurement in Patients With Complete Unilateral Cleft Lip and Palate.

With the recent advances of surgical adjuncts including presurgical naso-alveolar molding and postoperative nasal stenting, information on the anthropometric evaluation of cleft lip nasal symmetry after primary rhinoplasty is lacking. Twenty-nine nonsyndromic patients with complete unilateral cleft lip and palate undergoing modified rotation advancement cheiloplasty with synchronous primary rhinoplasty in our center were prospectively recruited in our study. All of them received our center's peri-operative management protocol, including presurgical naso-alveolar molding and postoperative nasal stenting. Direct anthropometric measurements of their nasal configuration were documented when they were anesthetized for primary lip repair at 3 months of age and for the primary palate repair at 12 months of age. Their nasal configurations were analyzed before primary rhinoplasty and at 9 months after rhinoplasty. There is a statistically significant change in nasal symmetry at 9 months after the primary rhinoplasty. There is no significant correlation between the nasal configuration before and at 9 months after the primary rhinoplasty. With significant relapse of nasal deformity at 9 months after the primary rhinoplasty despite the use of presurgical naso-alveolar molding and postoperative nasal stenting, overcorrection of the nasal configuration at primary rhinoplasty should be considered for optimal long-term nasal symmetrical outcome.

A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique.

Background:This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair.Materials and Methods:This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded.Results:There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty.Conclusions:We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.