Bilateral cleft lip revisions: the Abbe flap.

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Secondary deformities in bilateral cleft lip are common, presenting with scar contracture, vermilion deficiency, and upper lip tightness.
• Severe cases necessitate full-thickness tissue replacement for the central philtral unit, including vermilion, orbicularis oris, and skin.
• The Abbe flap provides a method for full-thickness reconstruction, addressing deficient tissue and restoring oral sphincter function.

Purpose of the Study:

• To evaluate the technique for secondary bilateral cleft lip revision using the Abbe flap.
• To demonstrate the successful application of the Abbe flap in reconstructing complex cleft lip deformities.

Main Methods:

• A review of operating room video files was conducted.
• Video clips from two secondary bilateral cleft lip revisions using the Abbe flap were analyzed.

Main Results:

• The Abbe flap has been successfully utilized for secondary bilateral cleft lip revisions at Texas Children's Hospital.
• A technique video was created using surgical footage from two cases.

Conclusions:

• The Abbe flap is an effective tool for reconstructing philtral landmarks, oral sphincter competence, Cupid's bow, and the central pout in bilateral cleft lip repair.
• Poor outcomes in cleft lip repair can result from improper use of prolabial tissue, failure to reunite the orbicularis muscle, and scarring.
• Successful Abbe flap reconstruction requires careful design of the philtrum, marking of landmarks, and meticulous dissection of the labial artery.