Frontal Reconstruction with Frontal Musculocutaneous V-Y Island Flap

Rocha, Lorenzo S; Paiva, Geruza Rezende; Oliveira, Luiz C de; Filho, Joel Veiga; Santos, Ivan D A O; Andrews, Jorge M.

doi:10.1097/01.prs.0000270294.76440.d1

Cited by 20 publications

(8 citation statements)

References 12 publications

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“…This technique appears to be better suited for older patients with more laxity of their tissues compared with young patients with tight skin and a low-lying hairline. 2,3,16,17…”

Section: Discussionmentioning

confidence: 99%

Triple-Plane Dissection of Combined Forehead and Scalp Flaps for Large Posttraumatic Forehead Defects

Saha

2020

International Journal of Recent Surgical and Medical Sciences

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Introduction Reconstruction of large (>20 cm2) posttraumatic forehead defects, with esthetically pleasing results and without distorting the surrounding anatomical landmarks like eyebrow and hairline, is a significant surgical challenge. This study was aimed to determine the effectiveness of a triple-plane dissection technique of significantly-sized flaps, combining forehead, and scalp to cover large forehead defects. Materials and Methods A retrospective review from January 2009 to December 2019 revealed that 12 patients with large defects over the forehead were operated on. Significantly-sized rotation and advancement flaps, combining both the forehead and scalp tissues, were performed. Triple-plane dissection and careful galeal scoring recruited more tissues and increased the reach of these flaps while maintaining adequate flap vascularity. Results Large forehead posttraumatic defects in all 12 patients were covered in a single surgery with this combined flap. Eight patients were men and four were women (mean age, 58 years). Size of the defects ranged from 21 to 40 cm2 (mean, 27 cm2). Complications included deep marginal necrosis in one patient (8%), superficial necrosis in one patient (8%), and mild venous stasis in four patients (33%). Superficial necrosis and venous stasis resolved by itself. Good color and contour match, minimal alopecia, maintained positions of eyebrow, and hairline positions were found in most patients. Six months postoperatively, patient satisfaction measured on a visual analogue scale ranged between 3 and 9 out of 10 (mean, 7). Conclusion Primary forehead reconstruction with significant-sized flaps combining forehead and scalp tissues, with triple-plane dissection and galeal scoring, appears to be an effective option for covering large forehead defects.

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“…This technique appears to be better suited for older patients with more laxity of their tissues compared with young patients with tight skin and a low-lying hairline. 2,3,16,17…”

Section: Discussionmentioning

confidence: 99%

Triple-Plane Dissection of Combined Forehead and Scalp Flaps for Large Posttraumatic Forehead Defects

Saha

2020

International Journal of Recent Surgical and Medical Sciences

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“…2 In case of smaller defects (up to 3-4 cm in diameter), primary closure with wide undermining of the galea enables excellent functional and aesthetic outcomes. 2,3,[13][14][15][16][17] In cases of preserved periosteum/remaining galea or even small circumscribed bone defects with intact dura coverage after tumor resection skin grafts can be used for coverage. 2,13,14 However, especially after radical oncological tumor resection, the periosteum is normally gone.…”

Section: Discussionmentioning

confidence: 99%

Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

et al. 2019

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Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.

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“…Although primary closure is ideal for small central forehead defects, for larger defects within this region the result often distorts the eyebrows and hairlines. 5,8,12,20 Secondary intention following a prolonged period of wound care can result also in contraction and similar distortions of natural hairlines and eyebrows. 1,6,8,10,25 Patients unable to endure even the necessary minimum 4 to 6 weeks of wound care might certainly benefit from a one-stage surgery that would include microvascular flap reconstruction such as we describe.…”

Section: Discussionmentioning

confidence: 99%

“…The most prevalent cutaneous malignant tumor encountered in the head and neck is basal cell carcinoma. [1][2][3][4][5] Other causes of forehead defects include trauma, burns (thermal or electrical), radiation injury, and infection. Multiple factors come into consideration when choosing the appropriate reconstructive approach.…”

mentioning

confidence: 99%

“…9,12 All stages of current forehead reconstructive approaches have been described in a plethora of literature including case series and reports. 1,2,5,6,[8][9][10][11][13][14][15][16][17][18][19][20][21][22][23] The efficacy of using aesthetic subunits of the forehead, however, is not described with consistency or uniformity. Additionally, a paucity of literature exists to describe the utility of microvascular flaps for aesthetic forehead subunit replacement.…”

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confidence: 99%

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