Defect-oriented reconstruction of extensive full-thickness lower lip defects using Fujimori gate flaps and Bernard-Burow-Webster advancement: a four-case series

We describe defect-oriented technique selection and outcomes in all four patients who underwent immediate one-stage reconstruction after wide excision of lower lip squamous cell carcinoma during the study period.

Two total defects with bilateral commissural loss were reconstructed with bilateral Fujimori gate flaps, and two large central full-thickness defects with preserved commissures were reconstructed with bilateral Bernard-Burow-Webster advancement. Clinical records and serial photographs were reviewed.

Frozen section and final margins were negative, and all flaps remained viable through the last outpatient follow-up. Median photographic and medical record follow-up periods were 122.5 days (range, 72-244) and 274.5 days (range, 136-758), respectively. No specific reconstructive complication was documented in Case 1. Case 2 had transient decreased sensation in the chin region through 2 weeks and drooling through 1 month, followed by improvement. Case 3 developed lower-lip ptosis, oral incompetence with drooling, marked firmness, restricted mobility, persistent food leakage and retention, and impaired eating. In Case 4, early stiffness, perceived reduction in oral aperture, and eating difficulty gradually improved. No secondary revision was performed.

Technique selection should consider defect extent and commissure status. Standardized functional assessment was unavailable, and this small, noncomparative series cannot establish superiority.