This video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article “Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique”. This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.
Preoperative markings for the unilateral cleft lip repair technique described by Dr. David Fisher.
Markings to be made prior to carrying out a unilateral cleft lip repair, and tattooed on prior to prepping the patient.
Using calipers and a marking pen, markings are made based on specific anatomic subunits and measurements. The patient is placed under general anesthesia and intubated prior to placing the markings. Measurements and markings are then made using a standard marking pen and calipers. The marks made are then tattooed onto the skin prior to prepping so that they are not lost during the prep. After tattooing, the patient is then prepped and draped in a sterile fashion and the unilateral cleft lip repair is carried out.
Detailed knowledge of lip anatomy is required including the cutaneous roll, vermillion border, wet-dry junction, philtral column, Cupid's bow, columellar crease, and nostril sill. knowledge of how these anatomic subunits are affected in children with cleft lips is useful and is highlighted in parts of the video.
Primary advantage - The repair line at the end of a unilateral cleft lip repair using this technique is oriented vertically along "seams" of the lip, allowing for positive scarring outcomes.
For the marking portion of the repair as described in this video, risks and complications are minimal. Risks include improper marking technique which would ultimately lead to a suboptimal cosmetic and/or functional outcome.
Fisher, DM. Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique. Plastic and Reconstructive Surgery. 2005; 116(1):61-71.