Cutting Court B, Warren Stephen M
Department of Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
J Craniofac Surg. 2013 Jan;24(1):75-8. doi: 10.1097/SCS.0b013e3182781fdc.
Nearly 60 years ago, Joseph Murray described several advancements to Bradford Cannon's Abbe flap reconstruction of secondary bilateral cleft lips in order to simplify the technique and improve results. Unlike their predecessors, Drs. Cannon and Murray modified the Abbe flap by splitting its apex in order to obtain a symmetrical correction of the upper lip and allow the 2 suture lines to extend vertically and laterally past the base of the columella and disappear within the floor of the nose. Eighteen years later, Dr. Murray reviewed the evolution of his own secondary cleft lip reconstruction experience to include a new approach to advance the maxilla rather than set back the mandible. In this Signature Issue, we reflect on contemporary innovations in secondary bilateral cleft lip Abbe flap reconstruction. Today, we approach the secondary reconstruction of the bilateral cleft lip in 3 stages. First, we establish normal anatomic positioning of the midface. Second, we perform secondary cleft nasal surgery as necessary. Finally, only after the midfacial skeleton and nose have been treated do we proceed with Abbe flap reconstruction of the upper lip. We inset the Abbe flap a quarter of the way out on the columella and wrap the Abbe darts around the sides of the columella. We find that designing the Abbe flap this way avoids the saber cut-like notching at the lip-columella junction, redundant vermilion, and excess flap length, and it also reduces or eliminates the need for upper or lower lip scar revision.
近60年前，约瑟夫·默里描述了对布拉德福德·坎农的双侧唇裂二期阿贝瓣重建术的几项改进，以简化技术并提高效果。与他们的前辈不同，坎农医生和默里医生通过劈开阿贝瓣的顶端来改进该瓣，以便对上唇进行对称矫正，并使两条缝线垂直和横向延伸至鼻小柱基部之外，并消失在鼻底内。18年后，默里医生回顾了他自己双侧唇裂二期重建经验的演变，包括一种推进上颌骨而非后缩下颌骨的新方法。在本期特刊中，我们思考了双侧唇裂二期阿贝瓣重建术的当代创新。如今，我们分三个阶段进行双侧唇裂的二期重建。首先，我们确立面中部的正常解剖位置。其次，我们根据需要进行双侧唇裂鼻二期手术。最后，只有在面中部骨骼和鼻子得到治疗后，我们才进行上唇的阿贝瓣重建。我们将阿贝瓣植入到鼻小柱四分之一处，并将阿贝瓣的尖端围绕鼻小柱两侧包裹起来。我们发现，这样设计阿贝瓣可避免唇-鼻小柱交界处出现剑状切口样切迹、多余的唇红以及瓣过长的问题，还减少或消除了对上唇或下唇瘢痕修复的需求。
