Secondary repair of cleft lip nose deformity using subcutaneous pedicle flaps from the unaffected side  Ikkei Tamada, Tatsuo Nakajima, Hisao Ogata, Fumio Onishi  British Journal of Plastic Surgery  Volume 58, Issue 3, Pages 312-317 (April 2005) DOI: 10.1016/j.bjps.2004.11.012 Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 Scheme of our procedure. (A) Subcutaneous pedicle flap from the unaffected nostril floor. The pedicle is small amount of orbicularis oris muscle. (B) Subcutaneous pedicle mucoseptal flap on the nasal fontanelle is everted 180° and moved to the affected side. Figure below shows the cross section of caudal portion of the mucoseptal area. The pedicle of the flap is areola tissue between the alar cartilages. (C) Subcutaneous pedicle mucoseptal flap is moved 90° to the nostril rim. The pedicle of the flap is areola tissue between the alar cartilages. British Journal of Plastic Surgery 2005 58, 312-317DOI: (10.1016/j.bjps.2004.11.012) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 Case 1. (A) Preoperative view. Subcutaneous pedicle flap on the unaffected nostril floor is transferred to the affected side. (B) One year after the operation. British Journal of Plastic Surgery 2005 58, 312-317DOI: (10.1016/j.bjps.2004.11.012) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 Case 2. (A) Preoperative view. (B) The subcutaneous pedicle muco-septal cartilage flap is everted 180° and move to the affected side. (C) One year after the operation. Nasal contour has become symmetrical with no functional disturbance. (D) Flap showed good survival. British Journal of Plastic Surgery 2005 58, 312-317DOI: (10.1016/j.bjps.2004.11.012) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 Case 3. (A) Preoperative view. Notch caused by scar on the left nostril rim and narrowed left nostril is visible. (B) Ten months after surgery. Both flaps showed good survival with good nasal symmetry. (C) and (D) Flap is turned 90° for covering tissue defect of the nostril rim. (E) and (F) Another subcutaneous pedicle flap is elevated on the right alar base and transferred to the left. British Journal of Plastic Surgery 2005 58, 312-317DOI: (10.1016/j.bjps.2004.11.012) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 5 Cooperative procedures we used. (A) Open reverse-U incision. From this access, not only inverted trapezoid suturing and box suturing, (showed below) but also subcutaneous pedicle flap techniques are easily produced and transferred to the cleft side. (B) and (C) Inverted trapezoid suturing technique. By using this technique, we can achieve the distinct alar groove, and the elevated aleolar tissue makes the clear contour of the nostril tip. (D) Two or three additional box sutures are placed subcutaneously over the nasal dorsum to make a well-defined nasal bridge. The knot of the suture is buried through a stab incision. British Journal of Plastic Surgery 2005 58, 312-317DOI: (10.1016/j.bjps.2004.11.012) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions