Making a Little History with the Chang Gung Cleft Lip Repair

1 Gavin Chun-Wui Kang, MD Department of Plastic, Reconstructive, and Aesthetic Surgery KK Women’s and Children’s Hospital Singapore Jung-Ju Huang, MD Division of Reconstructive Microsurgery Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital Taoyuan, Taiwan Department of Plastic Surgery Chang Gung Memorial Hospital Taoyuan, Taiwan Chun-Shin Chang, MD Graduate Institute of Chemical and Materials Engineering College of Engineering Chang Gung University Taoyuan, Taiwan Craniofacial Research Center Department of Medical Research Chang Gung Memorial Hospital Taoyuan, Taiwan Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital Taoyuan, Taiwan Yong Chen Por, MD Department of Plastic, Reconstructive, and Aesthetic Surgery KK Women’s and Children’s Hospital Singapore Philip Kuo-Ting Chen, MD Craniofacial Research Center Department of Medical Research Chang Gung Memorial Hospital Taoyuan, Taiwan Department of Plastic Surgery Chang Gung Memorial Hospital Taoyuan, Taiwan Jyh-Ping Chen, PhD Graduate Institute of Chemical and Materials Engineering College of Engineering Chang Gung University Taoyuan, Taiwan Yu-Ray Chen, MD Craniofacial Research Center Department of Medical Research Chang Gung Memorial Hospital Taoyuan, Taiwan Department of Plastic Surgery Chang Gung Memorial Hospital Taoyuan, Taiwan Sir: I has been 20 years since Noordhoff et al1 first published the Chang Gung modified rotation advancement technique for unilateral cleft lip and nasal deformity. Since then, Noordhoff and his staff and Chang Gung international fellows have gone on to perform unilateral cleft lip repair using this same technique faithfully and successfully for thousands of patients in Taiwan and worldwide transforming lives for the better. The Chang Gung repair is universally advocated alongside other well-known techniques as gold-standard unilateral cleft lip repair surgery.2,3 Serendipitously, 3 years ago, a friend of ours in Taiwan asked if we could help her 7-month-old Dachshund dog. It turned out that her dog was born with a left unilateral complete cleft lip, and aside from the aesthetic deformity, the dog had mild oral incompetence during feeding (Fig. 1). This was a situation we Chang Gung plastic surgeons could not refuse because for the first time in history we proceeded to repair the cleft lip of a dog using the Chang Gung technique. Under general anesthesia with oral intubation, the standard preoperative markings were made except they were adapted to suit the canine facial anatomy. Primary repair of the lip was accomplished using Polyglactin 3-0 suture (Vicryl, Ethicon, USA) suture with at least 6 knots per suture for extra security. True to the technique, no alar crease incision was required, and a laterally based vermillion flap was used to achieve the vermillion-mucosal junction balance. One dose of penicillin was administered postoperatively. An Elizabethan collar was kept on for 2 weeks to avoid trauma to the surgical site, and the postoperative course was uneventful. At 3-year follow-up (Fig. 2), the lip repair was stable, and the dog owner reported no further problems with feeding. We are proud to announce that the Chang Gung unilateral cleft lip repair is applicable to canine patients.