Columella reconstruction with Abbe flap

Columella reconstruction with Abbe flap . Procedure or method used for the reconstruction of the columella with the Abbe Flap design.

Summary

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  • 1 Description
  • 2 Development
  • 3 Clinical cases
  • 4 Discussion
  • 5 Source

Description

A method of reconstruction of the columella is described using a very long Abbe flap , taken from the lower lip . It can be useful in cases where it is necessary to reconstruct filtrum and columella, obtaining it in a single surgical time.

Development

The importance of columella in the harmony of the face, although of great importance, can go unnoticed, and only its absence makes it apparent.
Being one of the most difficult structures to rebuild, especially when it is totally destroyed by trauma or resections due to tumors, it has brought the attention of many surgeons, who developed techniques to repair it, some of them very complex.

Clinical cases

Patients who, due to a lip-palatal fissure , and after various surgical actions, came with serious sequelae, highlighting as more apparent the absence of filtrum and columella.

The patient did not accept a more complex surgery that globally corrected its sequelae, wishing only to partially improve his appearance. What most caught his attention, and for him was a priority, was the flattening and lack of symmetry of the upper lip due to the absence of filtrum and the absence of columella , delimiting, between both defects, a markedly sharp and shaped nasolabial angle incoming.

Discussion

Since Joseph published his work on columella reconstruction using a composite wing graft in 1992 , countless techniques have been described, many of them complicated, such as those described by Gillies in 1923 , Ivy in 1925 , Kazanjian in 1948 , Cardoso in 1958 , some of which required up to seven or eight times, such as that of Paleta and van Norman in 1962 .

In these cases presented, in addition to rebuilding the columella, the filtrum had to be rebuilt, and since the best way to rebuild the filtrum is given by an Abbe flap, it was thought to cut this flap much longer, so that it could reach the nasal tip, and thus correct both defects at the same time, significantly improving the nasolabial angle.

 

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