This flap is usually the first option in reconstruction of medium-sized upper and lower lip defects that do not involve the commissures. A full-thickness mucomusculocutaneous flap based on the medial or lateral labial artery is transposed in the opposite lip to the defect. It might be used by itself or in addition to other reconstructive measures such as perialar crescentic excisions.
Typically done in two stages, the Abbe flap is set in place in the first stage and divided 14-21 days later in a second-stage procedure. One-fourth to one-third of the lower lip can be taken without significant loss of function. Research has demonstrated evidence of muscle function in the transferred flap at its recipient site. Although this technique can be utilized for either lip, it is best for upper lip reconstruction since the lower lip has greater laxity and can contribute more tissue without disturbing a significant central structure. Furthermore, the Abbe flap can be used to replace the whole philtral subunit.
The Abbe flap does not recruit new lip tissue; it simply transplants tissue from the lower (or upper) lip to its counterpart. Thus, how big the oral aperture remains the same as if the lip defect is closed primarily. The goal is to recruit enough unaffected lip tissue to balance the discrepancy in lip lengths after a medium-sized excision.
A wedge-shaped pedicle flap is harvested in the opposite lip. At minimum the width of the flap should be one-half the size of the defect. The height of the flap should match the height from the defect, and the flap should be designed with sufficient tissue to permit a 180° arc of rotation to the defect. Because contralateral labial arteries form robust anastomotic connections in the midline, the flap could be based medially or laterally.
Starting at the apex, an incision is created through skin, muscle and mucosa and it is extended toward the vermilion border. As the vermilion border is approached, careful scissor dissection will avoid injury to the labial artery which can be found between your deep layers of orbicularis oris muscle and the mucosa approximately in the degree of the vermilion border. Initial division of the nonpedicle side from the flap can locate the positioning of the labial artery and aid in its identification on the pedicle side. The pedicle should be at least 1 cm in width in order to keep adequate venous drainage.
The flap is rotated upon its pedicle, and a stay suture is positioned after exact approximation of the vermilion border. The flap is secured having a three-layer closure approximating mucosa, muscle and skin, and the donor site is closed primarily or with crescentic excisions (labiomental or perialar depending on the donor site). The pedicle is usually divided 14-21 days later.
The most typical complication is flap loss because of inadequate circulation. Careful dissecting technique, an adequate soft tissue envelope around the artery, and ample flap width minimize flap ischemia. Consideration should be paid to the accurate approximation from the vermilion border of both donor and recipient sites before and after pedicle division.
Because the lower lip vermilion could be significantly thicker than that from the upper lip, resection from the vermilion can be undertaken in a secondary procedure for improved aesthetic result. Excessive pulling while raising the flap may result in the elimination of excessive muscle in the donor lip leaving a notched defect on the closure.
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