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Repair of a Secondary Cleft Lip Deformity With the Abbé Flap in a Pediatric Patient

Secondary cleft lip deformities are common. Over time, primary surgical correction of a cleft lip can become distorted resulting in suboptimal long-term functional outcomes in areas such as feeding, speech, and breathing as well as negative psychosocial consequences including negative peer interactions and social isolation. For these reasons, it is imperative to perform secondary revision surgery to ensure proper functional and social development. Reconstruction of secondary cleft lip deformities continues to be a challenge in plastic surgery. The Abbé flap has proven very versatile for the reconstruction of severe secondary cleft lip deformities. The original procedure designed by Abbe involved a flap based on the labial branches of facial artery with complete philtral reconstruction. A 12-year-old Hispanic female with a history of bilateral cleft lip and palate presented with a secondary cleft lip deformity. The patient underwent repair of her cleft lip and palate at 8 months and 3 years of age, respectively. Subsequently, the patient developed a secondary lip deformity which was a centralized scar contracture of the upper lip with missing philtral elements (Figure 1). Her past medical history was significant for other midline defects including holoprosencephaly and hypopituitarism. Therefore, the decision was made to perform an Abbé flap to correct the deformity. First, a philtral-shaped flap was marked out on the lower lip. Markings were then made for the planned excision and creation of the defect and scar excision on the upper lip that extended around the base of the nose. New lateral advancement flaps were marked for the pairing of the scar along the vermillion bilaterally (Figure 2). A scalpel was used to recreate the defect around the alar base, the centralized scar was excised and the orbicularis muscle was then identified laterally on both sides of the upper lip. After recreation of the defect, a buccal sulcus incision was made to allow for advancement of the lips to the midline bilaterally. After creation of the defect, attention was then directed at harvesting a lower lip flap, which was based centrally and a distal extent was just above the menton. This was accomplished by developing a full-thickness skin, muscle, and mucosal flap on the lower lip (Figure 3). A 4-0 Vicryl suture was placed to inset the philtral segment into the defect centrally. The inferior labial artery was identified upon division of the left side of the flap. It was left intact on the right side and adequate dissection was made to allow positioning of the flap into the defect, but with preservation of the arterial blood supply. A 4-0 Vicryl suture was placed to tack the Abbé flap centrally at the base of the nose. The lower lip defect was closed in layers with 5-0 Monocryl for the mucosal layer, 4-0 PDS for the muscle, and 4-0 Vicryl for the skin. Reconstruction of the