|The R-A repair is applicable to all unilateral cleft lips, incomplete (Fig.11) as well as complete (Fig.12).
POOL REPAIR (is it a modified R-A or triangle flap repair?) Pool9 recommends a "modified Millard repair" for complete clefts with tissue deficiency in the lateral element. The modification is to "lower" the R-A repair down into the lip. First, a horizontal line is drawn 2 to 3 millimeters below the columellar crease. The rotation cut continues up to this line, in which it continues (rather than in the columellar crease) until cupid's bow is released. A lateral transposition flap then fills the rotation defect.
This procedure is not a rotation-advancement modification; it is a modification of the rotation-transposition type of triangular repair. Instead of a straight line from the high point of cupid's bow into the midst of the philtrum, Pool uses a curvilinear line. From then on, it is a straightforward triangle repair. Because the lateral transposition flap is situated high in the lip (2-2.5mm below the columella) and the rotation scar does a better job of imitating the philtral column, Pool's method is the best of the triangular flap methods. However, for those preferring the unit principle in lip repair, the R-A method is clearly the procedure of choice.