Data-driven surgical planning for cleft lip repair: Optimization of individualized incisions using 3D finite element simulation and clinical translational validation.

Straight-line closure is a fundamental technique for repairing cleft lip (CLP), particularly suitable for mild unilateral clefts, valued for its simplicity and natural scar alignment. Understanding the biomechanical impact of surgical design, specifically incision area, is crucial for outcomes. This study utilized patient-specific 3D finite element (FE) modeling based on CT data to simulate the mechanical responses during and after straight-line repair with varying excision areas. Simulations analyzed stress/strain distributions, tissue deformation, displacement of key anatomical points (e.g., Cupid's bow peak), and incision tension. Results showed incision area significantly impacts outcomes: small incisions minimized tissue deformation, point displacement, and tension (aiding healing) but risked insufficient Cupid's bow descent; medium incisions achieved ideal Cupid's bow position, moderate deformation, acceptable and uniformly distributed tension, offering the best balance between reconstruction and healing; large incisions maximized correction but caused excessive deformation, Cupid's bow descent, high stress concentration, and significantly increased healing/scar risks due to excessive tension. The study concludes that medium-sized incisions provide the optimal compromise for anatomical reconstruction and long-term stability in straight-line CLP repair. Future work aims to integrate AI for automated biomechanical modeling and adaptive surgical plan optimization, advancing towards data-driven precision surgery.