One-Stage Lip-Switch

EDITORIAL COMMENT

Although this technique avoids the 1- or 2-week period of attachment, there is significant risk of loss of the flap, especially from venous congestion.

By modifying the Abbé lip-switch procedure for repair of full-thickness defects or deformities of the upper lip (1), a one-stage lip-switch technique was developed (2). This modification obviates the 1- to 2-week waiting period required for separation of the vascular pedicle.

FIGURE 161.1 Diagram of operative procedure. A: Preoperative design. Facial and lower labial arteries are illustrated. B: Mucosal closure of the transferred flap and pedicle. Modification of closure is shown in B‘. C: Completion of the procedure.

INDICATIONS

The one-stage procedure shortens the time required, thus ameliorating communication problems and discomfort in patients with significant disproportion between the upper and lower lip, especially in unilateral or bilateral cleft-lip deformities. An arterialized one-stage lip-switch operation can be rather risky compared to the traditional Abbé flap. Indications should be limited to properly selected patients. Various degrees of venous congestion or even necrosis in the traditional flap are not rare (3). Therefore, a sufficient quantity of submucosal tissue must be preserved for the long pedicle of a one-stage lip-switch flap.

ANATOMY

Asymmetries or variations in lower-vermilion vascularization have been described (3, 4), including cases with an equal distribution of the bilateral inferior labial arteries; predominant inferior artery of one side; the inferior labial artery present only on one side; or the inferior labial artery present as the terminal branch of the sublabial artery. The inferior labial artery may arise from a common trunk at the level of the labial commissure or directly from the superior labial artery (4, 5). In any case, numerous branches and terminals of the inferior labial, sublabial, mental, and submental arteries constitute an abundant labial network.

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