The dynamic Abbe flap.

A modification of the Abbe flap procedure is presented in which muscle-to-muscle union of the orbicularis muscle is obtained prior to inset of the flap. The technique consists in splitting the lip at the midline followed by dissection of the orbicularis muscle on each side from its abnormal position. The muscle is then rotated downward and sutured, restoring the oral sphincter. The flap is outlined on the lower lip and elevated. Following closure of the donor site, the Abbe flap is split in the coronal plane at the level of the muscle; this division is carried up to the mucocutaneous border, and the flap placed like a sandwich around the repaired muscle and sutured. The flap is usually divided in 14 to 16 days. The results have been good, with improved lip movement in 12 patients during animation.