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Gull-wing flap
Gull-wing flap
Oblong defects with a long horizontal dimension and short vertical component present a special challenge. Often they can be repaired with a niche reconstruction known as a gull-wing flap (Fig. 40-41).16 In patients with a suitable lip height, the defect may be incorporated into the arc of a seagullโs wing, with the center of the gull based at the vermillion border of the philtrum. The surgeon creates a similar pattern of excision and arc of advancement on the contralateral lip. Following excision and minor undermining, the flap is advanced superiorly, thus recreating the natural contour of the upper lip vermillion. This is not an advisable repair in patients with a short upper lip, as it may diminish the vertical height of the lip. As with a mucosal advancement of the upper lip, the gull-wing flap can expose a more pink vermillion and lead to scaling for a period of time.
Figure 40-41. Gull-wing flap for closure of a philtral wound at the lip margin. (A) Wound of the Cupidโs bow with a gull-wing flap designed. (B) The repair has been incised and elevated. (C) Immediate closure with restoration of the Cupidโs bow. (D) Final result at 1 year. (Used with permission from Dr. Todd Holmes).