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Abstract

Sir: We thank Dr. Jagannathan et al. for their letter about our Abbé flap article. Regarding their first statement regarding which side to base the flap on, we do not concern ourselves with that. If there is any issue regarding vascularity, we leave the mucomuscular bridge 9 to 10 mm, and that will always carry the flap whether the vessel is there or not. Regarding their second point: meticulous dissection of the artery is unnecessary in most cases. Cutting the first side tells us exactly where it is, and we rarely skeletonize the vessel. In the authors' Figure 1, we would have put the curved side more toward the right for better philtral similarity and brought the flap partially inside the nose. Also, the lower lip closure always gets a sublabial Z-plasty to prevent contracture across a concavity. It also seems that the labiomental fold is lowered too much; we would have taken the crescent out much higher with a Z at the junction and continued the vertical into the chin pad center to mimic a cleft. The most crucial point though is to leave at least a 10-mm “mucosal” bridge before any final dissection near the key vessel, skeletonization of which is rarely required. Leaving the mucosal bridge wider, we never suffer with the blueness the authors have shown. Barry M. Zide, M.D., D.M.D. Al Culliford, M.D. New York University Medical Center New York, N.Y.