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.