Abbe–Estlander Flap
Abbe–Estlander Flap
Large defects of the upper lip with substantial loss of lip margin present a reconstructive challenge. While large bilateral flaps can be used to accomplish closure of such wounds, a lip-sharing flap is often suitable.18–21 The appropriate wound for an Abbe flap is one that is broader than what would be reasonable for a lip wedge, and this usually corresponds to a wound of somewhat over ⅓ of the upper lip, but not more than ½ to ⅔ of the upper lip. Because a lip-sharing flap presents difficulty with nutrition, other options should be investigated first. The lower lip should be examined for suitability. Ideally the patient has a wider, rather than a narrower oral aperture.
To perform an Abbe flap the operative wound is triangulated as a lip wedge and the edges are squared to receive the flap. The Abbe flap is designed medial to the operative wound if feasible and is drawn as a match to the upper lip wound with just a slight undersizing being reasonable in many cases. The flap is then fully incised as a wedge, leaving the superficial orbicularis oris muscle band and the labial artery as a pedicle. Failure to include a reasonable muscle pedicle will lead to venous congestion and can cause flap failure. The lower lip is closed as a lip wedge, and the upper lip is closed in a multilayer fashion starting with the mucosa. Matching up the vermillion border can be challenging. The muscle layer of orbicularis oris should be carefully reapproximated at closure.
The pedicle should be left in place for at least a week, and usually 2 to 3 weeks prior to flap division. At division, the labial artery has often miniaturized; frequently, only little bleeding is encountered. As the flap matures it will often pincushion and may have a bulky appearance, even with proper design and execution. Over 6 months to a year the flap will usually reinnervate, first developing sensation and then motor function. Within a year, the reconstructed lip is usually fully functional.