Journal of Cleft Lip Palate and Craniofacial Anomalies

CASE REPORT
Year
: 2014  |  Volume : 1  |  Issue : 1  |  Page : 62--64

A simple innovation for improving the donor site scar of the Abbe flap


Nitin J Mokal1, Mahinoor F Desai2,  
1 Department of Plastic Surgery, Sushrusha Hospital and B.J. Wadia Children's Hospital, Mumbai, Maharashtra, India
2 Bombay Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Mahinoor F Desai
C/12, Khalakdina Terrace, August Kranti Marg, Mumbai - 400 036, Maharashtra
India

Abstract

The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midline lower lip scar of the donor site can lead to a bridging contracture when it crosses the labiomental crease. By addition of a small Z-plasty we can ensure that the concavity of the crease is maintained with a superior aesthetic result.



How to cite this article:
Mokal NJ, Desai MF. A simple innovation for improving the donor site scar of the Abbe flap.J Cleft Lip Palate Craniofac Anomal 2014;1:62-64


How to cite this URL:
Mokal NJ, Desai MF. A simple innovation for improving the donor site scar of the Abbe flap. J Cleft Lip Palate Craniofac Anomal [serial online] 2014 [cited 2021 Feb 26 ];1:62-64
Available from: https://www.jclpca.org/text.asp?2014/1/1/62/126576


Full Text

 Introduction



"The ABC of plastic surgery begins with a Z" is a line oft quoted to plastic surgery novitiates. We have applied the basic principles of Z-plasty to a commonly performed procedure of upper lip reconstruction using the lip switch flap.

The lower lip to upper lip full thickness switch flap was first described by Pietro Sabbatini for a post-traumatic defect of the upper lip in 1838. [1] Robert Abbe described a similar flap 60 years later in order to augment a tight and scarred upper lip caused by bilateral cleft lip deformity. [2] Today this flap is widely known by the latter's name and is used liberally for a variety of upper lip reconstructions.

The technique of harvest has been well-described in the literature. [3] A typical design includes a wedge shaped flap taken from the midline of the lower lip. The flap width is half that of the anticipated defect since the change in length of both lips is reciprocal. In cases of cleft lip revision, the width of the flap corresponds to the dimensions of the new philtrum. The flap is incised full thickness through skin and vermilion, leaving a small pedicle of labial mucosa containing the inferior labial artery. [3] A meticulous three-layered closure of both, the donor and recipient sites is standard. The pedicle is divided at a second stage 10-14 days later.

Our intention is to present a modified method of closure of the lower lip defect following flap harvest which we feel greatly increases the aesthetic outcome of the donor site.

 Case Report



A total of 25 Abbe flap procedures were done over a period of 5 years by a single surgeon for the secondary correction of philtral aesthetics in cases of bilateral cleft lip deformity. All the patients in our series had a tight and scarred upper lip which needed tissue augmentation in addition to the aesthetic deformity.

We harvested the flap from the central portion of the lower lip using the standard technique and a V-shaped wedge design. However at the time of closure, instead of doing a straight line repair, we incorporated a small Z-plasty at the level of the labiomental crease [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

Pedicle division was performed at 10 days in all patients. No complications were seen in the early or late post-operative period. A 3 month post-operative follow-up of the same patient reveals a well settled scar, partly hidden in the labiomental crease with well-maintained concavity of the crease [Figure 3] and [Figure 4].{Figure 3}{Figure 4}

 Discussion



The Abbe flap as it stands today is an essential tool in the armamentarium of the cleft surgeon. When taken from the mid-portion of the lower lip, it reproduces the central fullness of the upper lip thus producing a semblance of the Cupid's bow. In an effort to reduce the donor site morbidity that this procedure entails, we have evolved our technique over the years. The addition of the Z-plasty at the lower end of the Abbe donor site is the result of this effort.

The Z-plasty is a fundamental technique which has a long history of being used by plastic surgeons though its first description is somewhat disputed. [4] Among other things it functions to break up a straight line scar/contracture, to reorient tissues from one area to another and to obliterate a web or cleft. [5]

We believe that when applied to the Abbe flap donor site, the Z-plasty modification helps break the line of the scar and changes its direction and hence part of it now lies along a natural skin crease. This makes the final midline scar less conspicuous as it is partly camouflaged within the labiomental crease. It also eliminates the chances of a bridle scar contracture which may happen in case of the traditional straight line closure, due to the linear scar contracting across a concave surface.

The addition of the Z-plasty at the time of closure of the Abbe flap donor site is a simple technique, does not significantly increase the operating time and has no additional morbidity for the patient. When combined with the previously mentioned aesthetic benefits especially in a cosmetically sensitive area such as the face, the routine incorporation of the Z-plasty seems an obvious choice for the closure of the midline lower lip defect. By extension, this addition of a Z-plasty can also be used while closing post-traumatic or post-oncologic resection defects involving the lower lip.

References

1Mazzola RF, Hueston JT. A forgotten innovator in facial reconstruction: Pietro Sabattini. Plast Reconstr Surg 1990;85:621-6.
2Abbe R. A new plastic operation for the relief of deformity due to double hare lip. Med Rec 1898;53:477-8.
3Cormack GC, Lamberty BG. The Arterial Anatomy of Skin Flaps. New York: Churchill Livingstone; 1994. p. 354.
4Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg 1973;26:237-46.
5Furnas DW. The four fundamental functions of the X-plasty. Arch Surg 1968;96:458-63.