A three-layer lip-switch flap similar to the Abbe flap can be used in the area of the oral commissure.
1. The flap is based on the commissure and is outlined in the lower lip area (Fig. 6.24a). It is rotated 180° and sutured into the wedge-shaped defect in the upper lip (Fig. 6.24b, c).
Fig. 6.24 The Estlander flap
(1872) is similar to the Abbe flap used at the angle of the mouth. The wedge-shaped flap, based on the inferior labial artery, is rotated around the angle of the mouth into the defect. a The Estlander flap is cut through all layers of the lower lip. b The flap is rotated into the upper lip defect. c All defects are closed. d About 16-20 days later the pedicle is divided, the triangular mucosal flaps are mobilized, and the lip is closed (see Fig. 6.56). e, f A Z-plasty is added for closure of the donor site. The Estlander flap can also be used for lower lip reconstruction.
2. The pedicle is divided about 16-20 days later. If desired, revision of the rounded commissure can be done as a secondary procedure (Fig. 6.24d). Bilateral Estlander flaps can also be used.
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