Modified use of gate flap for the reconstruction of the lower lip

Surgical excision of advanced lower lip carcinomas with adequate safety margins, in some cases, causes defects as large as three-fourths of the width of the lip or total lip defects. This paper describes a modification of nasolabial 'gate flap' for reconstruction of extensive defects of the lower lip. Splitting the flap into skin and mucosal flaps provides the surgeon more skin on the inferior aspect of the reconstruction where he needs skin without any mucosa and more mucosa on the superior aspect of the reconstruction where he needs mucosa for reconstruction of the vermilion and lower labial sulcus. Four patients with total lower lip defects have been treated with this technique. The results were quite satisfactory both functionally and cosmetically.