Biography of Pietro SabattiniIn 1838, Pietro Sabattini was nominated Director of Surgery at the S. Maria della Scaletta Hospital, Imola, where he worked until his death. In 1847, he produced an accurate review of the literature of the Ancient Greeks up to the reneissance.
Variations on a theme by Sabattini
Pietro Sabattioni was an Italian surgeon from the University of Bologna. In 1837, at the S. Orsola Hospital, he repaired a posttraumatic upper lip defect using a fullthickness composite flap from the lower lip that was vascularized by means of a narrow pedicle containing labial vessels. He published this in 1838, in Italian. That is probbably the reason why few surgeons learned about his discovery.
In 1848, the Danish surgeon Sophus August Vilhelm Stein (1797-1868) withouit any knowledge of Sabattini’s work, published an account in the local medical journal on a similar operation on a sailor. Stein used two triangular flaps raised from the upper lip and transposed to repair a defect in his lower lip. Due to their small size, the flaps were safer and the tension of the closed defect5 was distributed more evenly. The pedicle could be sectioned after three weeks. Stein also used single vascular flaps, but never published a paper on this method.
Unfortunately, Stein’s work, being published in the Danish language, suffered the same fate as Sabattini’s, very few learned about it.
In Finland, Jakob August Estlander (1831-1881) of Helsinki in 1865 described the Stein type of flap repair for the reconstruction of a lower lip destroyed by gangrene after typhoid. Estlander’s method for reconstructing defects of the lip near the commissures yelded excellent results. This approach often required a second operation to reconstruct the commissure and restore the size of the mouth, allowed the surgeon to avoid awkward situation of a vascular pedicle crossing the mouth in a vulnerable position, and the necessity of a second operation to section this base.
”In the year 1871, a 63-year-old farmer presented with a carcinoma of the lower lip. One of his assistants performed the usual operation, but it was complicated with a recurrence. Estlander removed the lesion and rotated tissue from the corner of the right upper lip into the defect. The triangle of tissue was quite long, extending along the side of the nose, with the base of the flap bordering along the upper lip.
Rotating the flap easily around the corner of the mouth and in effect creating another corner of the mouth, Estlander discovered that, in spite of the apparently large size of the defect, it was corrected easily by the flap. The patient was gratified with the result as he was not able to hold a piece of bread in his lip which had been impossible after the first operation.
Another case described a face which had been ravaged by the effects of Typhus, probably an early example of Noma. Following the removal of scar tissue, a flap was created from the lower lip extending quite a bit below the lower edge of the lower jaw, and was kept live in the intact coronal vessels (inferior labial).
Further, a third case documented another gangrene of the face (Noma) complicated by a systemic disease (Typhus). In this instance, the face was reconstructed from a flap taken from the upper lip and cheek.”
From: Frank W. Pirruccello: Plastic and Reconstructive Surgery of the Face: Flaps of the Head and Neck. Williams & Wsilkins, 1982.
In 1898, Robert Abbe of New York City wrote his account for the reconstruction of an old congenital cleft using ”his” musculocutaneous labial flap.
Estlander stated that he had never come across any reference in the literature to the use of vascular flaps for labial reconstructions and therefore could not have known about the discoveries of Sabattini and Stein, both of which were published in the authors’ native languages.
The question if Robert Abbe was aware of the work of Estlander is an entirely different matter, because the Finnish surgeon published his findings in German, a language that was current in the scientific community, 26 years before Abbe used his vascular flap. Furthermore, in 1876 Estlander was invited by many American medical institutions to lecture on this subject on a well publicized tour.
An Abbe flap should be called a 'Sabatini' and an Estlander a 'Stein'. By 1907 seventy-four different techniques for reconstructing the lips and mouth had been described.