40761 Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

Name of the Procedure:

Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

Summary

This surgical procedure is performed to correct a cleft lip and associated nasal deformities. It utilizes a cross lip pedicle flap technique, where tissue is transferred from the lower lip to the upper lip to reconstruct the area. This method helps create a more natural appearance and function of the lip and nose.

Purpose

• Medical Condition: Cleft lip and nasal deformities, often congenital.
• Goals: To reconstruct and restore the normal appearance and function of the lip and nose, improve speech and eating abilities, and enhance the patient's overall facial aesthetics.

Indications

• Severe cleft lip deformity.
• Associated nasal deformities causing functional or aesthetic issues.
• Poor outcomes from previous cleft lip repair surgeries.
• Healthy patient, typically beyond infancy, with a cleft lip and nasal deformity.

Preparation

• Pre-procedure Instructions: Fasting for 8 hours prior to surgery; avoid certain medications as instructed by the surgeon.
• Diagnostic Tests: Physical examination, blood tests, imaging studies like X-rays or CT scans, pre-anesthetic evaluation.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A precise incision is made around the cleft lip and nasal deformity.
3. Pedicle Flap Harvesting: A flap of tissue, connected to its original blood supply, is taken from the lower lip.
4. Transfer and Securing: The flap is transferred to the upper lip, correctly positioned, and secured using sutures.
5. Sectioning Pedicle: The pedicle flap is meticulously sectioned and inserted to integrate seamlessly with the surrounding tissues.
6. Closure: The surgical site is closed with fine sutures.
7. Dressing: The area is cleaned and dressed appropriately.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the deformity.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center equipped with the necessary facilities.

Personnel

• Surgeons: A plastic surgeon, often specialized in cleft repairs.
• Nurses: Surgical nurses to assist during the procedure.
• Anesthesiologists: To administer and monitor anesthesia.

Risks and Complications

• Common Risks: Infection, bleeding, scarring, discomfort or pain.
• Rare Risks: Flap necrosis (death of tissue), asymmetry, need for revision surgery, adverse reactions to anesthesia, nerve damage.

Benefits

• Expected Benefits: Improved appearance and function of the lip and nose, enhanced self-esteem, better speech and eating capabilities.
• Realization Time: Benefits are often noticeable after recovery, around 2-3 months post-procedure.

Recovery

• Post-procedure Care: Keep the surgical area clean and dry, follow specific wound care instructions, take prescribed medications for pain and infection prevention.
• Recovery Time: Approximately 1-2 weeks for initial recovery, with full recovery and final results visible in a few months.
• Restrictions: Avoid strenuous activities for about 4-6 weeks, follow-up visits for monitoring progress.

Alternatives

• Other Options: Non-surgical treatments (if minimal deformity), different surgical techniques (e.g., direct closure, use of local flaps).
• Pros and Cons: Non-surgical options are less invasive but may be less effective; other surgical techniques may be simpler but not provide the same cosmetic and functional results as the Abbe-Estlander flap.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel any discomfort during the surgery.
• Post-procedure: Some swelling, bruising, and mild pain are expected; pain management includes prescribed analgesics. Patients may also feel tightness or altered sensation in the lip and nasal area initially, which will gradually improve with time. Regular follow-up appointments will help ensure a smooth recovery.