Research Article Beyond Fifty Years of Millard’s Rotation-Advancement Technique in Cleft Lip Closure: Are There Many “Millards”?

Copyright © 2012 Renato da Silva Freitas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In 1955, Millard developed the concept of rotation-advancement flap to treat cleft lip. Almost 6 decades later, it remains the most popular technique worldwide. Since the technique evolved and Millard published many technical variations, we decided to ask 10 experienced cleft surgeons how they would mark Millard’s 7 points in two unilateral cleft lip patient photos and compared the results. In both pictures, points 1 and 2 were marked identically among surgeons. Points 3 were located adjacent to each other, but not coincident, and the largest distances between points 3 were 4.95mm and 4.03mm on pictures 1 and 2, respectively. Similar patterns were obtained for points 4, eight of them were adjacent, and the greatest distance between the points was 4.39mm. Points 5 had the most divergence between the points among evaluators, which were responsible for the different shapes of the C-flap. Points 6 also had dissimilar markings, and such difference accounts for varying resection areas among evaluators. The largest distances observed were 11.66mm and 7mm on pictures 1 and 2, respectively. In summary, much has changed since Millard’