THE ABBE FLAP IN SECONDARY CLEFT LIP REPAIR (CLINICAL CASE)
DOI:
https://doi.org/10.35220/2078-8916-2023-48-2.14Keywords:
Abbe flap, elimination of secondary deformity of the upper lip, non-fusion of the upper lipAbstract
Secondary deformities of the cleft lip are unfortunately very common, and severe cases can involve scar contracture, vermilion deficiency, and a tight upper lip. In these cases, reconstruction often requires replacement of the central philtral unit with full-thickness tissue, including vermilion, m. orbicularis oris, and skin. Results of cleft lip repair are often poor because of inappropriate use of the hypoplastic prolabial tissue, failure to anatomically reunite the orbicularis muscle, and scarring. Purpose. This article reports on the Abbé flap for correction of mild tightness of the corrected cleft lip and nose deformity. Patients and methods. 12 patients with a moderately tight lip deformity, from 18 to 25 years old, underwent this procedure. 9 had a unilateral deformity and 3 a bilateral deformity. The flap, which was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid's bow. It was inserted into the center of the upper lip and the pedicle was divided 1 week after operation. Technique. The Abbe flaps in this series were taken from the middle of the lower lip to replace a portion of the upper lip. Lip height to the nose or to the labiomental fold was assessed at the preoperative visit so that postoperative lip height could be correlated to the pre-existing anatomy. Conclusion. Use of modified Abbé flap to reconstruct the contour of the vermilion tubercle and the Cupid's bow makes the upper lip look more natural. Even though maxillofacial reconstructive surgery has undergone a sea change from the use of traditional flaps to the present day microsurgical free tissue transfer, Abbe still holds in a position as a reliable method of lip reconstruction. Our experience with 12 patients with Abbe flap reconstruction has been encouraging and the result obtained was extremely satisfactory. The Abbe flap procedure gives satisfactory results in the secondary reconstruction of deficient upper lips in persons with cleft lip. The width of the flap must be 1 to 1.5 cm, the length should be sufficient to reach the base of the columella, the shape triangular or shield-shaped, and the position medial. The tissue transfer from the lower lip creates philtral dimple and philtral ridges. Disadvantages of the Abbe flap include patient discomfort and the need for multiple procedures.
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