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Plastic Surgery International
Volume 2012 (2012), Article ID 731029, 4 pages
Research Article

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

1Section of Plastic and Reconstructive Surgery, Federal University of Paraná, 80060-240 Curitiba, PR, Brazil
2Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
3Section of Plastic and Reconstructive Surgery, São Paulo University, 01246-903 São Paulo, SP, Brazil
4Section of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Received 2 August 2012; Accepted 4 November 2012

Academic Editor: Luis Bermudez

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 4.95 mm and 4.03 mm 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 4.39 mm. 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 11.66 mm and 7 mm on pictures 1 and 2, respectively. In summary, much has changed since Millard’s initial procedure, but his basic principles have survived the inexorable test of time, proving that his idea has found place among the greatest concepts of modern plastic surgery.