Abbe-Estlander operation

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Abbe-Estlander operation is a surgical procedure for lip reconstruction, in which a flap of tissue from one lip of the mouth is grafted to the other lip, in order to correct a defect from trauma, vascular malformations, surgical wound or infections.[1][2][3] This is done using a pedicle (i.e., part attached to the donor site) that has an arterial supply.

As Abbe-Estlander usually refers to using a section of the lower lip to reconstruct the upper lip, the so-called "reverse Abbe flap" or "Estlander-Abbe flap" refers to using tissue from the upper lip to reconstruct a defect in the lower lip.[3]

History

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Also known as a cross-flap operation, it was named after R. Abbé (1851–1928), an American surgeon, and J. A. Estlander (1831–81), a Finnish surgeon.[4]

Indications

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Abbe-Estlander flap can be used to repair defects of one-third to two-thirds of the upper or lower lip. In cases of larger defects, it may be employed to reconstitute the oral commissure together with other methods of reconstruction.[5] Estlander flaps are suited for patients with a full thickness defect of a lip up to and including the commissure.[3]

In addition to repairs due to trauma, surgical removal of lesions[1] or cancerous tissue,[6] vascular malformations, or infections, it can, in some cases, be used to correct small upper lip defects.[7]

Although upper lip defects of 25% or less and lower lip defects of 33% or less can be closed primarily, the Abbe flap may be used in small defects where the philtral column is involved and requires reconstruction.

Procedure

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In the Abbe-Estlander procedure a portion of the intact lip (upper or lower) is rotated across the mouth and into the defect of the damaged lip, while maintaining the blood supply from the labial artery. The blood supply of the flap will be established to the point where the artery can be divided, in 10–14 days. The second-stage procedure, is done to divide and inset the flap, to reestablish the commissure.[3]

The Abbe flap has an excellent cosmetic result when it is used to replace the entire philtrum of the upper lip. Preferably, the flap is taken from as close to the oral commissure as possible, in order to allow for more proximal blood supply, and to maintain the oral opening as wide as possible. The repair process then takes two surgeries with attention to assure continuity of the vermilion border.[3]

  • Large squamous-cell carcinoma (SCC) of lower lip
    Large squamous-cell carcinoma (SCC) of lower lip
  • Suture intraoperatively
    Suture intraoperatively
  • Followup 12 days after 1st surgery
    Followup 12 days after 1st surgery
  • Followup 12 days after 1st surgery
    Followup 12 days after 1st surgery

Some notable cases in medical journals include repairs after severe injusy, lesion[1] or carcinoma excision,[8][9] and a secondary cleft lip reconstruction.[6]

Complications

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Although in most indicated cases of lip reconstruction, the Abbé-Estlander flap is associated with minimal risk of flap failure,[9] there can be less desirable consequences.[5]

Sources

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  1. ^ a b c "Husein Husein-ElAhmed, Department of Dermatology, Hospital de Baza – Granada, Spain; Rafael Armijo-Lozano, Department of Dermatology, San Cecilio University Hospital - Granada. Spain, Lower lip reconstruction using a skin-mucosa Abbe-Estlander flap after squamous cell carcinoma excision". Anais Brasileiros de Dermatologia (through the National Library of Medicine, NIH). Archived from the original on 9 February 2025. Retrieved 15 August 2025.
  2. ^ "Medical Dictionary". Medical Dictionary - Dictionary of Medicine and Human Biology. Archived from the original on 19 February 2025. Retrieved 19 June 2025.
  3. ^ a b c d e "Simon G. Talbot; Julian J. Pribaz, Repair of Lip Commissure Defects With Estlander Flaps". Plastic Surgery Key. Archived from the original on 15 August 2025. Retrieved 15 August 2025.
  4. ^ "Abbé–Estlander operation (also known as a cross-flap)". Oxford Reference. Retrieved 14 August 2025.
  5. ^ a b "Michael Eggerstedt MD; Ryan M. Smith MD; Peter C. Revenaugh MD, FACSm, Estlander flap for lip reconstruction". ScienceDirect Operative Techniques in Otolaryngology-Head and Neck Surgery. Retrieved 15 August 2025.
  6. ^ a b "Erol, Onur O. MD; Pence, Murat MD; Agaoglu, Galip MD, The Abbé Island Flap for the Reconstruction of Severe Secondary Cleft Lip Deformities". Journal of Craniofacial Surgery. Archived from the original on 31 May 2024. Retrieved 15 August 2025.
  7. ^ "Robert Beinrauh, Joseph H. Dayan, Repair of Lip Defects With the Abbe Flap". Plastic Surgery Key. Archived from the original on 15 August 2025. Retrieved 15 August 2025.
  8. ^ "Husein Husein-ElAhmed, Department of Dermatology, Hospital de Baza – Granada, Spain; Rafael Armijo-Lozano, Department of Dermatology, San Cecilio University Hospital - Granada. Spain, Lower lip reconstruction using a skin-mucosa Abbe-Estlander flap after squamous cell carcinoma excision". SciELO Brazil - Scientific Electronic Library Online. Archived from the original on 24 November 2023. Retrieved 14 August 2025.
  9. ^ a b "Hyung Jin Hahn; Hyun Jee Kim; Jin Young Choi; Soo Young Lee; Young Bok Lee; Jin Wou Kim; Dong Soo Yu, Transoral Cross-Lip (Abbé-Estlander) Flap as a Viable and Effective Reconstructive Option in Middle Lower Lip Defect Reconstruction". Annals of Dermatology. Archived from the original on 16 April 2025. Retrieved 14 August 2025.

See also

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