Commissure-Preserving Modification of the Gate Flap for Reconstruction of Large Lower Lip Defects

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oral and Maxillofacial Surgery

Background:

• Lower lip defect reconstruction demands techniques balancing aesthetics and function (speech, oral competence).
• The traditional unilateral gate flap (Fujimori flap) is effective for large defects but often disrupts the oral commissure.
• Preserving the oral commissure is crucial for optimal functional and aesthetic outcomes in lower lip reconstruction.

Purpose of the Study:

• To describe and evaluate a modified unilateral gate flap technique designed to preserve the oral commissure.
• To assess the safety, efficacy, and functional outcomes of this modified flap in patients with significant lower lip defects.

Main Methods:

• A modification of the unilateral gate flap involving de-epithelialization and subcutaneous tunneling was developed.
• Twenty-five modified gate flaps were performed in 22 patients with lower lip defects (≥50% of lip) between 2014 and 2022.
• Outcomes including flap survival, complications, and functional results (oral competence, lip function) were evaluated postoperatively.

Main Results:

• No flap loss was recorded in the 25 procedures.
• Minor complications such as transient edema and wound dehiscence occurred but were managed conservatively.
• Oral competence and lower lip function were maintained in most patients, particularly when the reconstruction was the primary repair.

Conclusions:

• The modified unilateral gate flap is a safe and effective single-stage technique for lower lip reconstruction, successfully preserving the oral commissure.
• This modification maintains the core principles of the Fujimori flap while addressing the limitation of commissure disruption.
• It offers a practical reconstructive option for selected cases where oncological appropriateness allows for commissure preservation.