Repair of Lip Defects With the Abbe Flap

Robert Beinrauh

Joseph H. Dayan

DEFINITION

A full-thickness portion of the lower lip, which includes the mucosa, orbicularis oris muscle, and skin with vermilion, based on the right or left inferior labial artery with mucosal venous attachments¹
Used in reconstruction of defects of the upper lip (which do not involve the commissure) between one-third and one-half of the entire lip
A reverse Abbe flap (Estlander-Abbe flap) is the exact same flap only taken from the upper lip to reconstruct lower lip defects not involving the commissure.
- We will use the technique for the traditional Abbe flap for this chapter, but recognize the reverse flap is the same technique based on the superior labial artery.

ANATOMY

The lips are a sphincter composed of a concentric ring of mucosa, muscle, and skin, which form a tight seal to prevent liquid from escaping the oral chamber and also to produce the labial sounds used in speech.
Orbicularis oris muscle:
- A circumferential ring of muscle around the mouth that functions to compress and purse the lips together
- The muscle fibers run horizontally on the upper and lower lips and begin at the modiolus.
- There is an oblique extension of the muscle that runs from the commissure to the anterior nasal septum and nasal floor.
The inferior labial artery branches from the facial artery at the angle of the mouth.
- The artery runs inside the lip several millimeters inferior and anterior to the vermilion/mucosal junction of the posterior lip² (FIG 1).

PATHOGENESIS

Lip deformities can be congenital or acquired.
Congenital deformities are most commonly cleft lip defects.
Acquired deformities are most commonly due to traumatic or neoplastic etiologies.

PATIENT HISTORY AND PHYSICAL FINDINGS

Abbe flap is an excellent choice for defects of up to approximately 50% of the upper or lower lip.
Upper lip defects of 25% or less and lower lip defects of 33% or less can be closed primarily. However, the Abbe flap may be useful even in these relatively small defects if the philtral column is involved and requires reconstruction.
Lip defects larger than 50% of the lip may require either larger flaps, staged reconstruction, or a flap from a distant tissue site. However, there is some patient-to-patient variability in these size considerations due to anatomic considerations (ie, the baseline size of the lower lip) and the degree of skin laxity.
The Abbe flap is used for defects that do not involve the lip commissure. The Estlander flap is more useful for more lateral defects that involve the commissure. Abbe flap is excellent for reconstruction of bilateral cleft lip patients with scarred or short philtrums.³

FIG 1 • Cross section of the lip showing inferior labial artery.

IMAGING

No imaging is necessary for the Abbe flap. However, a pencil Doppler can be helpful to confirm position of inferior labial artery.

SURGICAL MANAGEMENT

Preoperative Planning

Size of the defect and layers of lip involved must be assessed.
The orbicularis oris muscle must be reconstructed to restore lip competence and avoid cosmetic deformities (eg, whistle deformity) with lip movement.
In general, the size of the lower lip Abbe should be less than 30% of the width of the lower lip to avoid microstomia. However, as noted, there is some variability based on skin laxity and anatomic considerations.

Positioning