Bilateral cleft lip revisions: The abbe flap

Background: Secondary deformities of the bilateral cleft lip are unfortunately very common, and severe cases can involve scar contracture, vermilion deficiency, and a tight upper lip. In these cases, reconstruction often requires replacement of the central philtral unit with full-thickness tissue, including vermilion, orbicularis oris, and skin. The Abbe flap offers full-thickness reconstruction of the central aesthetic unit of the upper lip by replacing the deficient and scarred tissue and restoring functional competence to the oral sphincter. Methods: A review was performed of the authors/ operating room video files to evaluate their technique for performing secondary bilateral cleft lip revision using the Abbe flap. Results: The Abbe flap has been used successfully for secondary revisions of the bilateral cleft lip at the Texas Children/s Hospital. A technique video was made using video clips from two secondary bilateral cleft lip revisions. Conclusions: Results of bilateral cleft lip repair are often poor because of inappropriate use of the hypoplastic prolabial tissue, failure to anatomically reunite the orbicularis muscle, and scarring. The Abbe flap is an effective tool for reconstruction of the philtral landmarks, reconstitution of oral competence of the orbicularis, and recreation of Cupid/s bow and the central pout. Although this procedure is relatively straightforward, special attention to designing the new philtrum, marking intact landmarks, and careful dissection of the labial artery are required for successful reconstruction.