Role of Abbe Flap in Treatment of Secondary Cleft Lip Deformity

Abstract

Abbe flap is a lip switch procedure which first described by Robert Abbe in 1898 for the secondary correction of a bilateral cleft lip deformity. A shield-shaped full thickness lower lip flap based on inferior labial artery was used to reconstruct the upper lip defect which may be due to congential anomalies, trauma or neoplasm. Indications includes tight upper lip, irregualr vermilion, notching, loss of Cupid's bow, upper lip scar or after upper lip resection. In general the Abbe flap has been reserved for the most severe defomity, however it seems that during the continuous treatment course of cleft lip deformity whenever the tendency of maxillary retrusion been observed the Abbe flap should be considered immediately. This is usually start to be found somewhere around 5 years of age. Its advantages include tissue similarity, spontanous reinnervation, low lip reduction and anatomical landmark sparing. From 1982 to 1993 there were 30 Abbe flaps, 23 female patients and 7 male patients, been performed in National Taiwan University Hospital, all of them were due to secondary cleft deformities. The oldest case was a 38-year-old female and the youngest was a 7-year-old male. The average hospitalized day was 3.9 days (2 to 6 days). The pedicle of flap was divided 2 weeks after the flap was placed under local anesthesia. The post-operative results were satisfactory both cosmetically and functionally. The Abbe flap was a relative simple procedure. We strongly believe a lot of maxillary retrusion of secondary cleft lip deformities are due to tight upper lip, and early release of tight upper lip can prevent from further progress of maxillary retrusion. For those older patient, cosmetic gain and functional restoration are still worthwhile for the procedure.