Abbe-Estlander Flap Research Articles

Comparative evaluation of postoperative functional and esthetic outcomes for lip reconstruction with Fujimori gate flap versus Abbe-Estlander flap in patients being operated for oral squamous cell carcinoma

Background: Lip carcinomas account for 23.6% to 30% of tumors affecting the oral cavity. Lip reconstruction aims to achieve a competent oral sphincter with a good cosmetic appearance while avoiding microstomia. There are various techniques for lip reconstruction like Fujimori gate flap, Abbe-Estlander Flap, Gillies fan flap, Nasolabial flap, Karapandzic flap, bilateral advancement flap, perialar crescentic advancement flap, Bernard-Burow flap, and free flap. Aims and Objectives: To compare the Fujimori gate flap and Abbe-Estlander flap in terms of functional and esthetic outcomes when used for reconstruction of the lip. Materials and Method: Ten patients diagnosed with oral squamous cell carcinoma requiring resection and reconstruction of lip were included in the study. Functionally, maximal interincisal opening, lip competence, speech intelligibility and esthetically, scar, symmetry of lip during mouth opening, and symmetry of lip at rest were evaluated at the end of 1 week and 1 month. Results: On evaluation of functional and esthetic parameters, the Fujimori gate flap provides superior results in terms of mouth opening, speech intelligibility, and symmetry of lip at rest. However, results were comparable in both groups in terms of lip competence, scar, and symmetry of lip during mouth opening. Conclusion: The results of this study suggest that the Fujimori gate flap provides superior results with respect to function and esthetics when used for the reconstruction of lower lip defects with minimal or less complications.

Reconstruction of acquired lip defects: Ten-year experience at a tertiary care center

AimThe purpose of this paper is to describe different acquired conditions necessitating lip reconstruction and present our ten-years’ experience in managing the same at a tertiary care hospital. Materials and methodsData of patients undergoing reconstruction of acquired lip defects from January 2009 to December 2019 were analyzed for demographic details, etiology, extent of defect, reconstruction option used, outcome and complications. Results89 patients underwent lip reconstruction after excision of malignant tumors (81%), vascular malformations (12%) and traumatic injuries (7%). Mucosal and cutaneous lip defects were seen in 8 (9%) and 3 (3%) patients respectively, which were treated by primary closure, local advancement flap and tongue flap. Full thickness defects involving less than 1/3rd of lip (36%) and involving up to 2/3rd of lip (33%) were treated by primary closure, Abbe, Abbe Estlander flap and Karapenzic, Bernard Webster & peri-alar crescentic flaps respectively. Sub-total lip defects were repaired using distant and free vascularized flaps. All the localized cutaneous/mucosal defect repair healed uneventfully. Complications associated full thickness defect reconstruction included reduced stoma, flap necrosis and hypertrophic scar. ConclusionsRepair of localized cutaneous/mucosal defects of lip are simple with no significant documented complication. However, full thickness tissue loss necessities careful surgical planning. The choice of surgical technique depends on the extent of lip length lost. While Karapandzic flap was most commonly utilized to reconstruct lip defect involving up to 2/3rd of the lip, radial forearm flap was a choice in managing subtotal lip tissue loss.

Lip reconstruction technique: A modified Abbe-Estlander with a myomucosal advancement flap

Lip cancer represents between 12–15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

Versatility of abbe-estlander flap in lip reconstruction - a prospective clinical study.

Aim of this study was to evaluate the versatility of Abbe-Estlander flap in lip reconstruction with regard to function and aesthetic outcome and objectives were to present our experience and result in series of 10 cases of lip reconstruction by Abbe-Estlander flap. A total number of 10 patients were taken up in the study, age ranging from 35-71 y, mean age being 60. Out of 10 patients, 6 (60%) were male and 4 (40%) female. In all these patients, Abbe-Estlander flap that involved the commissure was used for reconstruction. Patients were recalled at intervals of three weeks, three months and six months for follow up. All patients had satisfactory results in terms of aesthetic and functional outcome. Abbe-Estlander flap is safe and a reliable flap which is technically simple to perform, and provides functionally and aesthetically pleasing result and affords versatility in flap design.

Clinical application of lower cross-lip flap in treatment of upper lip defect

Objective To evaluate the clinical effect of the upper lip defect with lower cross-lip flap (Abbe-Estlander flap).Methods A total of 68 cases of upper lip defect underwent the reconstruction with cross-lip flaps.We applied Abbe flap in upper lip defect in the center,and Estlander flap in lateral upper lip defect.This method was a two-stage procedure:the first stage was to rotate flap 180 degrees into the upper lip defect and to suture with the created defect of the upper lip,with careful maintenance of blood supply from the pedicle; the second was to undertake the division of bridged pedicle and paid more attention to creation of the vermilion border.Results The flaps survived in all cases.Evaluation from 3 to 12 months after the operation showed that the shape of lips were obviously repaired with excellent aesthetic and functional results.Conclusions Abbe-Estlander flap could reconstruct anatomical features and function of the lip precisely.It seems that within certain limits (probably between one-third and one-half of total upper lip length),this flap appears to be the preferred method for upper lip reconstruction. Key words: Lip flap; Abbe-Estlander lip flap; Upper lip defect

A new technique for reconstruction of lower-lip and labial commissure defects: a proposal for the association of Abbe–Estlander and vermilion myomucosal flap techniques

Reconstruction of large lower-lip defects is a complex surgical procedure, especially when associated with defects that compromise the oral commissure. Various wide resections have been proposed with the aim to preserve orolabial function and achieve a pleasant esthetic result. However, no consensus exists on the optimum procedure. We propose a new technique that combines an Abbe-Estlander flap with a vermilion myocutaneous lower-lip flap. Five consecutive patients presenting with lower-lip and oral commissure defects underwent surgical procedure. Surgical outcomes were analyzed based on oral competence, symmetry, sensibility, ability to wear denture prostheses, and postoperative complications. All patients achieved satisfactory functional and esthetic results during the 12-month follow-up period. The association of the Abbe-Estlander flap and the vermilion myomucosal lower-lip flap provides reliable results for the reconstruction of small and large defects involving the lower lip and the oral commissure.

Estratégias em reconstrução do lábio inferior

INTRODUCAO: Os labios superiores e inferiores representam as estruturas anatomicas funcionais e esteticas mais importantes do segmento inferior da face. Alem disso, possuem funcoes complexas, sendo a reconstrucao de defeitos labiais um desafio ao cirurgiao plastico. METODO: Trinta pacientes apresentando defeitos de espessura total do labio inferior foram submetidos a reconstrucao do labio baseada na extensao dos defeitos apos exerese tumoral. RESULTADOS: Seis (20%) pacientes apresentavam lesoes de ate 30% da superficie total do labio, sendo realizado fechamento primario. Dezoito (60%) pacientes apresentavam lesoes de 30% a 80% da superficie total do labio inferior, sendo realizado retalho miomucoso de vermelhao; em 14 desses pacientes, em decorrencia da perda cutânea associada a resseccao, foi associado retalho cutâneo mentolabial. Cinco (16,6%) pacientes tinham lesoes no labio inferior e comissura oral adjacente, sendo submetidos a reconstrucao pela tecnica de Abbe-Estlander com retalho miomucoso associado ao retalho cutâneo mentolabial. Um (3,5%) paciente apresentou lesao de 90% da superficie total do labio inferior, sendo empregada tecnica de Webster-Bernard associada ao retalho de lingua. CONCLUSOES: Neste artigo e apresentada, de forma simplificada, sistematica e baseada na literatura, uma estrategia para planejamento da reconstrucao do labio inferior com utilizacao de tecnicas eficazes e reprodutiveis em ambiente de aprendizado de medicos residentes, para tratamento de lesoes complexas do labio inferior, baseadas na extensao da perda de tecidos apresentada pelo paciente, com adequados resultados estetico-funcionais.

Lower lip reconstruction with Abbe–Estlander flap modification: preserving the same side vascular pedicle

A 74-year-old man was referred to our clinic with a nonhealing crusted lower lip ulcer. On examination, an ulcerated lower lip lesion measuring 1.5 9 1.5 cm was detected at a location 1 cm from the left oral commissure approaching the midline. There was no palpable lymphadenopathy in the neck. An incisional biopsy was carried out and the lesion was reported as squamous cell carcinoma. Supra-omohyoid bilateral neck dissections were performed and the tumor was excised. Vertical full-thickness incisions were made so as to leave a safety margin of 1 cm. The defect measuring 3.5 cm was reconstructed utilizing an ipsilateral upper lip Abbe–Estlander flap, which was prepared with 3-cm length and 1.5-cm base, preserving the superior labial artery. The left upper labial artery sank deeply into the submucosal plan of the mobilized flap (Fig. 1, 2). The upper lip defect was reconstructed by primary closure. Histological examination of the specimen confirmed no metastasis in the neck, with a negative surgical margin. No complications developed in the following 6 months with satisfactory esthetic and functional results. According to the defect location and size, various lip reconstruction methods have been described. ‘’ V ‘’ or ‘’ W ‘’ shaped excision and primary closure are sufficient for smaller than 30 % lower lip defects. In 35–70 % of lower lip defects, the Karapandzic, Abbe, Estlander, McGregor or Gillies’ fan flaps, the Nakajima or Schuchardt flaps or their modifications can be used. In cases in which there is insufficient tissue in the lower lip, cheek tissue is used in Webster, Bernard and Dieffenbach advancement flaps and their various modifications. Deltopectoral or radial forearm free flaps can be options for large defects of the lip extending to the mandible [1–5]. The Abbe–Estlander flap, which is fed by the opposite superior labial artery, is a full-thickness triangular-shaped upper lip flap that creates the oral commissure and the lateral part of the lower lip. This flap begins from the medial part of the oral commissure and is approximately 1.5 9 3 cm in size. Direct rotation to the defect is completed at one stage. In our case, the lower lip was reconstructed using the modified Abbe–Estlander flap following tumor resection. We describe a method that is different from conventional methods, which protects the ipsilateral superior labial artery. It is not necessary to sacrifice the superior labial artery, which is encountered in the incision line when creating the flap. Additional dissection to expose the artery, such as that in facial arterial dissection, is not required. Therefore, no co-morbidity of the facial muscles occurs. At first, the mucosal layer of the flap is sutured to the defect area after having released a small part of the muscle. Thereafter, the flap is sutured to the defect area while preserving the artery, which is between the mucosa and the muscular layer of the flap. Protecting the ipsilateral superior labial artery does not complicate the mobility and the processing of the flap. Our modification, which goes with an intact contralateral facial artery in terms of flap feeding, may not have superiority to the classical Abbe– Estlander flap for patients who have never undergone a surgical procedure to the neck. However, in patients who This manuscript had been presented at 33rd. National Congress of Oto-Rhino-Laryngology Head and Neck Surgery, Antalya, 26–29 October 2011.

Videolaryngoscopy offers advantages over classic laryngoscopy in a patient with seriously limited lip opening

To the Editor: Inability to intubate the trachea is a leading cause of anesthesia-related injury [1]. Videolaryngoscopy offers advantages over direct laryngoscopy and is less traumatic [2, 3], as the miniature videocamera on the tip of the blade enables the intubator to provide an indirect view of the upper airway. We report a patient with limited lip opening in whom videolaryngoscopy proved to be helpful to provide a patent airway. A 73-year-old woman (160 cm; 75 kg; American Society of Anesthesiologists [ASA] physical status II), scheduled for lip reconstruction following lower lip cancer, underwent extensive lower lip resection with upper lip rotation (AbbeEstlander flap) to fill the lower lip defect [4]. Both lips were sewn together for 6 weeks, leaving an oral opening of 2.6 cm (intercommissural width). At the time of lip reconstruction (dividing the pedicle and releasing the lips), the patient showed asymmetric and limited mouth opening (interincisor distance 1.2 cm, oral width 2.6 cm; thyromental distance 6.8 cm; Mallampati grade IV), normal neck movement, and an adequate oral space. Precautions were taken to deal with a difficult airway: i.e., the provision of a difficult airway trolley, and personnel skilled in performing a surgical airway. After preoxygenation, anesthesia was induced with i.v. propofol 200 mg. Face mask ventilation was successful with capnographic tracing, and 100 mg succinylcholine was administered. The narrow mouth orifice prohibited any direct vision of the oral cavity during direct classic laryngoscopy (Cormack–Lehane grade IV), resulting in excessive tension on both lips. Channeled indirect videolaryngoscopes (Pentax-AWS , Tokyo, Japan; Airtraq , Prodol-Meditec, Vizcaya, Spain) were considered, but they were found to be too bulky to fit into the patient’s mouth, and failed to work, indicating that the wider blades of channeled videolaryngoscopes are a weak point. The insertion of a V-MAC videolaryngoscope (Karl Storz , Tutlingen, Germany), which consists of a less wide Macintosh-blade size three, into the mouth (Fig. 1) showed a Cormack–Lehane grade I on the monitor, and oral endotracheal intubation was successful at the first attempt, without the need to use a stylet. Normally a Macintosh-blade laryngoscope is introduced into the right side of the mouth, deflecting the tongue to the left, and the length of the blade is passed over the contour of the tongue. Subsequently the tongue is lifted upwards and forwards, so that enough room is created next to the blade to both visualize the glottic entrance and to insert the endotracheal tube in situ. In this patient no such maneuvers were an option. This case highlights the advantage of indirect videolaryngoscopy (Macintosh intubation blades incorporating optics in the tip for video-imaging) in patients with very limited mouth openings. The intubator does not need to see the vocal cords directly, as videolaryngoscopy offers both better laryngoscopic views and more successful intubations than classic laryngoscopy [2, 3, 5]. Management of difficult laryngoscopy in the patient with seriously reduced opening of the lips offers a unique and ongoing challenge for the anesthetist. With the present A. van Zundert (&) B. Pieters Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Michelangelolaan 2, NL-5623EJ, Eindhoven, The Netherlands e-mail: zundert@iae.nl

Combination of two local flaps for the reconstruction of oral commissure

The management of defect after oral commissure excision remains a significant reconstructive challenge. Surgical reconstruction of oral commissure brings to restore both symmetry of lips at rest and more importantly full oral competence. A method for the reconstruction of mucosal carcinoma involving oral commissure is described. We used a combination of nasolabial flap and Abbe-Estlander flap

O.243 Finding an algorithm for microvascular bony reconstruction

Lip cancer represents between 12–15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

Two cases of lip cancer reconstructed by the abbe-estlander technique

Squamous cell carcinoma of the lip is an uncommon disease in Japan. This report describes two cases of lip cancer which were reconstructed by the Abbe-Estlander technique with good aesthetic and functional results. The first case was a 72-year-old male. He noticed a mass on the left lower lip and underwent biopsy, which revealed moderately differentiated Squamous cell carcinoma. We performed surgical resection of the tumor and reconstructive surgery using an upper lip flap (Abbe-Estlander flap), followed by additional reconstruction a month later. The second case was a 26-year-old male. He noticed a mass on the left upper lip and underwent biopsy, which revealed well differentiated squamous cell carcinoma. We performed a tumor excision and reconstruction using a lower lip flap. There has been no evidence of recurrence or metastasis in either case during the follow-up period.

Dog bite of the face in an adult Nigerian-a-case-report

Dog bite of the face is uncommon in adults. This is, in fact very rare in our environment and presentation of this single case to our centre led to our desire to discuss both the presentation and management of the patient in this paper. An adult female Nigerian who had dog bite to her face involving both lips and the commisure is presented. The folder of the patient and the operation note were the sources of the information. She had minimal debridement of the wound with Abbe-Estlander flap cover of the wound. The dog was also placed under surveillance for a period of 2 weeks. The wound healed perfectly with no complication. The involved dog remained healthy 2 weeks after the injury. Dog bite of the face, though uncommon, can present in an adult. Sometimes the challenges of reconstruction of such defect could be great. Wound management with minimal debridement and closure gives good results on the face.

"How I do it"--plastic surgery. Practical suggestions on facial plastic surgery. A modification of the Abbe-Estlander flap for defects of the lower lip.

"How I do it"--plastic surgery. Practical suggestions on facial plastic surgery. A modification of the Abbe-Estlander flap for defects of the lower lip.

Reinnervation of an Abbe-Estlander and a Gillies Fan Flap of the Lower Lip: Electromyographic Comparison

Electromyographic examination of a left Gillies fan flap 29 months after operation and of a right Abbe-estlander flap 17 months after operation showed complete motor innervation of both.