Héctor Ortíz-Martínez, Plastic and Reconstructive Surgery Service, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
Rodolfo L. Ríos-Lara y López, Plastic and Reconstructive Surgery Service, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico


Objective: A surgical proposal is presented for the management of total lower lip defects based on the technique described in 1980 by Fujimori, called gate flap. The most common cause of total lip defects is oncological resections; likewise, epidermoid cancer represents more than 90% of the types of cancer in the lip. Reconstructive management after excisional treatment requires extensive anatomical knowledge of the area, and free flaps are currently the gold standard for total lower lip defects. It is for this reason that after a review of the surgical options described, we made modifications to the Fujimori gate flap. Materials and Methods: The gate flap modified by us consists in a unilateral musculocutaneous flap, generating less donor site morbidity, and adding a palmaris longus tendon graft, performing a double pulley system for reconstruction of the oral sphincter, achieving adequate fluid continence. Three cases of elderly patients with total defects of the lower lip are presented. Results: We found that Modified Gate Flap are superior to the gold standard (radial free flap). Achieving adequate skin coverage, restoration of the oral sphincter, shorter surgical time, they do not present complications associated with the procedure. Conclusions: The ideal reconstruction should have not only an adequate aesthetic appearance, but also the restoration of function, associated with the lowest incidence of complications, with reproducible and constant results, which lead to a high degree of satisfaction of the patient and the surgical team; Same scenario we found with our therapeutic option.



Keywords: Lower lip reconstruction. Gate flap. Lip neoplasia. Lip diseases. Reconstructive surgical procedures.