Abstract
Objective
To evaluate outcomes of precision dermal fat grafting (PDFG) for vermilion deficiency following cleft lip repair.
Design
Retrospective cohort study.
Setting
Tertiary care pediatric hospital.
Patients
Individuals with vermilion deficiency following repaired unilateral or bilateral cleft lip.
Interventions
Dermal fat grafts were placed at the site of deficiency. Grafts were oriented with dermis-side contacting and secured to the orbicularis oris, then covered with a V-Y mucosal advancement flap.
Main Outcome Measures
Upper lip measurements were obtained from pre- and postoperative photographs. Two vertical heights were measured from the point of greatest deficiency: (1) actual height—from the point of greatest deficiency to the upper vermilion border, and (2) expected height—from the upper to the lower vermilion border. Two reviewers performed measurements; interrater reliability was assessed using the intraclass correlation coefficient (ICC). Associations between patient factors and revision surgery were analyzed.
Results
The vermilion height ratio improved from 0.72 to 0.94 postoperatively (P < .001), demonstrating increased vermilion volume. ICC was 0.81 (95% CI: 0.72-0.87), indicating excellent interrater reliability. Patients requiring revision had a lower preoperative actual-to-expected vermilion height ratio compared to those not requiring revision (P = .043), suggesting that more severe initial defects may increase the likelihood of revision. Five patients required revision: 4 for excess (treated with excision) and 1 for deficiency (requiring repeat PDFG).
Conclusions
PDFG is a safe and reliable technique for correcting vermilion deficiency in unilateral and bilateral cleft lip, offering predictable volume restoration with minimal complications.
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