Bilobed Flap
Facial and Lip Reconstruction With Abbe Estlander Flap, Skin Cancer, Kevin Kavanagh



  • Slide 1. Preoperative AppearanceThe patient has a squamous cell carcinoma involving almost one half of the lower lip.
  • Slide 2. Lip Incisions OutlinedA "V" shaped incision is outlined to resect the cancer. The tip of the "V" does not cross the skin crease between the lip and the chin. A flap from the upper lip equal to one half the defect is outlined. It is based medially on the superior labial artery.
  • Slide 3. Cancer ResectedUsing a #11 blade the cancer is removed. The technique used is that described in the "V" Resection Surgical Presentation.
  • Slide 4. Upper Flap Rotated Into PositionThe upper flap is rotated into position. Great care is taken not to cut the superior labial artery. Near the artery only the skin is cut. Blunt dissection is used to divide the deep tissues to lessen the chance of injuring the artery.
  • Slide 5. Closure of First Stage ReconstructionThe flap is sewn in place and the donor site closed using a 5-0 Nylon Stitch. If the patient has dentures, be sure they are taken out prior to surgery.
  • Slide 6. One Day Postoperative AppearanceThe appearance one day after surgery.
  • Slide 7. One Week Postoperative AppearanceThe appearance one week after surgery.
  • Slide 8. Six Week Postoperative AppearanceThe appearance six weeks after surgery.
  • Slide 9. Planned Incisions Second StageThe planned incisions to release the flap. The flap will be divided and the margin of the flap is rotated into the lateral lip to align the vermillion cutaneous junction.
  • Slide 10. Closure of Second and Final Stage ReconstructionThis picture shows the closure after the second and final stage of the reconstruction.
  • Slide 11.  Three Month Postoperative AppearanceThe three month post operative result with the lip at rest. ( The next slide shows the function of the lower lip )
  • Slide 12. Three Month Postoperative AppearanceThree month postoperative result with the patient whistling. Note that innervation and function has returned to the flap. Listen to the patient whistling.

Abbe Estlander Flap for Lip Reconstruction in a
Patient With Skin Cancer of the Lower Lip

This flap has a named artery and an excellent blood supply.  The pedicle of the flap is very small.  The biggest disadvantage is that two operations are required and the patient must have his lips sewn together for 4 to 6 weeks.  The blood supply to this flap is from the superior labial or inferior labial artery, both are branches of the facial artery and are of the external carotid artery system.  The flap is usually based medially, otherwise it may be very difficult to rotate into position.

Play to Hear Patient Whistle After Surgery:



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