Repairing of defect in forehead with frontalis musculocutaneous island flap / 中华医学美学美容杂志

ABSTRACT

Objective To introduce a better operation method to repair the skin and soft tissue defects in the forehead.Methods This kind of frontalis musculocutaneous flap was applied to repair the skin and soft tissue defects in the forehead in 8 cases.The flap was designed carefully according to the shape and the size of the focal lesion before the operation. The maximum area of the flap was 2.9cm?1.6cm, and the minimum area was 1.2cm?1cm. The full flap contained muscle in its proximal area and skin, muscle, and fascia in its distal one. A muscular pedicle with appropriate length was outlined on the paramedian and lateral forehead. The pedicle was composed of frontalis muscle fibers, the terminal part of the frontal branches of the superficial temporal artery, and some small branches from the supraorbital and the supratrocheal arteries. The body of the flap was designed into triangle shape. Full thickness skin was incised around the inverted pattern of the defect. The skin of the paramedian and lateral aspect was then undermined laterally. Superficial dissection was carried out in a subcutaneous layer. The flap was undermined beneath the galea and frontalis muscle just external to the skull. The muscle pedicle was prepared by incising a parallel horizontal incision. Careful attention should be taken so as not to injure the vascular pedicle. At that time, the supraorbital and supratrocheal arteries were carefully ligated to obtain complete hemostasis. Then the flap was advanced and transferred down to cover the wound in the forehead. The donor site could be sutured directedly by undermining the margins of the defect without much difficuties. Results All flaps in 8 cases survived. Venous congestion was observed in early postoperative period in only one case. But the flap survived completely after proper management in final healing. Follow-ups were made from 6 months and 12 months after operations. The color and texture of the flaps were similar to the adjacent skin in the forehead. The shapes were satisfying. Conclusions This kind of flap is a much better method for the repairing of some small or moderate defects in the forehead. It can be easily operated and allow a rapid aesthetic restoration.