Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Reconstructive Surgery in the Tropics
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Figure 55. Left) Tennison’s technique of cleft lip repair. Right) Make the incisions with a
sharp knife as indicated after careful measurements. Place stay sutures at 4 and 4'. Make
each length equal to its partner after closing the mucosa. Dissect deep to the nasal alae
to release it. (a’ to 2' must be equal to 2).
Figure 56. Left) Giraldes technique of cleft lip repair. Right) 1' to 3' must equal 1 to 3.
The final nostril openings must be equal. The resulting lip margin should have a fullness.
17.Separate the skin from the muscle on both sides of the cleft with a sharp
knife for a distance of 0.5 cm.
18.Approximate the muscle layers starting with a to a’.
19.Then approximate the muscle layers of 2 to 2', 1 to 1', 3 to 3', and 4 to 4'.
20.Place additional sutures of absorbable 3-0 vicryl if necessary.
21.Approximate the skin with interrupted 6-0 chromic sutures.
22.Place antibiotic cream over the incision and tincture of benzoin on either
side of the repair out onto the cheeks.
23.Place steristips across the repair gently approximating the upper lips so
that tension on the incision is demonstrated.
24.Place a small catheter in the nostrils and suture them in place with 5-0
chromic to maintain a good airway.
25.Place a protecting gauze over the incision with tape.
26.Use an elbow arm restraint on babies and small children.
27.Watch the patient closely the first 6 hours and then slightly less closely
the next 18 hours.
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