Acellular human dermis, a good option for correcting the free border deficiency in secondary cleft lip deformity

Free border deficiency is often seen after repairing the primary cleft lip. Mild deficiency of this area can be corrected by rearranging available local tissue, but, in severe cases, the absolute shortage of tissue requires recruitment of other tissues for a satisfying result. Although many types of materials have been used, filling materials alone have not provided favourable results. We have therefore attempted to overcome these limitations by combining V-Y advancement of the labial mucosa, with providing additional tissue to the deficient area with acellular human dermis or temporoparietal fascia. From September 2001 to January 2009, a combination of acellular human dermis or temporoparietal fascia graft with mucosal V-Y advancement was performed on 20 patients with free border deficiency of secondary cleft lip. Ten patients received temporoparietal fascia graft, and the others received acellular human dermis grafts. Results were evaluated by the surgeon based on the aesthetic appearance and consistency of the free border of the upper lip. All 20 patients were satisfied with the results. There were no significant differences in absorption rate, texture and volume between the acellular human dermis and temporoparietal fascia group. There were no complications such as infection, graft exposure and epidermal cysts in both groups. The use of acellular human dermis is a simple and effective method for managing severe cases of free border deficiency. Combined with V-Y advancement of the labial mucosa, it is as effective as temporoparietal fascia, offering long-lasting results without major complications in managing this difficult problem. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.