Dr. Juna Gurung
Clinical Fellow
Topic
Current Concept in Cleft Surgery
Chapter 15: Technical Description and Outcome of L’s Modified Furlow’s Double-Opposing Z-Plasty Procedure
This chapter describes Lo’s modified Furlow’s double-opposing Z-plasty for primary cleft palate repair, integrating principles of Bardach’s two-flap palatoplasty with refined Furlow techniques. The procedure emphasizes meticulous muscle dissection, retropositioning, soft-palate lengthening, tension-free closure, and preservation of maxillary growth. It is applicable across Veau I–IV cleft palates, with deformity-specific modifications. The current protocol favors one-stage repair at approximately 9 months of age. Technical refinements, including pyramidal space dissection, selective relaxing incisions, and buccal fat pad coverage, aim to minimize fistula formation and velopharyngeal insufficiency while achieving satisfactory speech outcomes and reducing the overall burden of cleft care.