Choice of Incision for Primary Repair of Unilateral Complete Cleft Lip: A Comparative Study of Outcomes in 796 Patients
Choice of Incision for Primary Repair of Unilateral Complete Cleft Lip: A Comparative Study of Outcomes in 796 Patients
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单侧完全性唇裂一期修复切口的选择：796例患者结果的比较研究
DOI：
10.1097/01.prs.0000299282.63111.3f
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发表时间：
2008
影响因子：
3.6
通讯作者：
A. Markus
中科院分区：
文献类型：
--
作者：
G. Reddy;R. Webb;R. Reddy;L. Reddy;P. Thomas;A. Markus
背景：没有一种唇裂修复技术能持续产生理想的美学和功能效果。这项研究是在一个发展中的高容量中心进行的。它比较了使用两种不同设计的皮肤切口用于单侧完全性唇裂的一期闭合所获得的结果，并试图确定最适合不同形态的唇裂的技术。方法：796例患者进入研究。在每组略少于400例患者中，使用改良的Millard或Pfeifer波浪线切口，两者均结合Delaire所述的下层组织的功能性修复。术前记录唇和鼻的软组织测量值。分析基于术后对白色卷、朱红边缘、疤痕、丘比特弓、唇长、髋臼对称性以及髋臼圆顶和底座外观的评估。结果如下：使用Pearson卡方检验比较两个队列的相关性和线性趋势，发现Millard切口的朱红匹配结果明显更好，而Pfeifer方法的术后唇长更好。一种特定技术更适合某些术前裂隙解剖形式的先入之见没有得到统计学证明。结论：某些术前解剖特征可能导致外科医生优先选择一种特定的切口模式，但在本研究中，发现一种技术基本上与另一种技术一样好。这表明，关闭下面组织的技术可能更重要。
Background: No one technique of cleft lip repair consistently produces ideal aesthetic and functional results. This study was carried out in a developing, high-volume center. It compares outcomes attained using two different designs of skin incision used for primary closure of unilateral complete cleft lip and sought to identify the most appropriate technique for clefts of varying morphology. Methods: Seven hundred ninety-six patients were entered into the study. In each group of slightly less than 400 patients, either a modified Millard or Pfeifer wavy line incision was used, both in conjunction with functional repair of the underlying tissues as described by Delaire. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid’s bow, lip length, and nostril symmetry and appearance of the alar dome and base. Results: Comparison of the two cohorts using Pearson chi-square testing for association and linear trend found a Millard incision gave significantly better results for vermilion match, whereas the Pfeifer method led to a better postoperative lip length. Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. Conclusions: Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another, but in this study, it was found that one technique was essentially as good as the other. This suggests that the technique for closure of the underlying tissues is probably of more importance.