Medial Canthus Reconstruction with the Paramedian Forehead Flap

Abstract

Background: The medial canthus represents the medial confluence of the upper and lower eyelid margins and plays an integral role in the lacrimal duct system. Various flaps have been utilized for the reconstruction of the lower eyelid in the medial canthal region. Our institution primarily utilizes the paramedian forehead flap for the reconstruction of medial canthus defects. Our study looked to evaluate the work of a single plastic surgeon and identify their postoperative outcomes. Methods: A retrospective chart review was conducted at Beaumont Health System, Royal Oak, for patients who underwent medial canthal repair by the lead surgeon between the years 2014 and 2018. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. Results: A total of five patients were isolated. Patients underwent paramedian forehead flap medial canthal repair by the lead surgeon and were found to tolerate the procedure well. All patients had clinically viable flaps with aesthetically pleasing results. Conclusions: Utilization of the paramedian forehead flap leads to successful medial canthal repair with adequate coverage. Although the paramedian forehead flap requires three stages to complete, the procedure leaves patients with aesthetically pleasing results. In addition, the paramedian forehead flap has limited cases of ectropion. With the right expertise and patient population, the paramedian forehead flap can be highly successful in the repair of medial canthal defects.

Danger Zone for Paramedian Forehead Flap Elevation: Maximizing Flap Length and Viability

“…Although flap dissection initially leaves an apparent forehead defect, resolution occurs through successive tissue remodeling and leaves overall cosmetic outcomes that are viewed positively by both the patient and surgeon [19]. Paramedian forehead flaps provide several other advantages, including providing ample tissue to cover large defects, and can be used to correct congenital [20] or acquired lesions [9,21,22]. Additionally, the paramedian forehead flap can be reused to repair remnant defects [23,24], as well as having the inherent flexibility to be modified by reconstructive surgeons to best suit individualized, patient-specific midfacial features [8,22,25].…”

“…Paramedian forehead flaps provide several other advantages, including providing ample tissue to cover large defects, and can be used to correct congenital [20] or acquired lesions [9,21,22]. Additionally, the paramedian forehead flap can be reused to repair remnant defects [23,24], as well as having the inherent flexibility to be modified by reconstructive surgeons to best suit individualized, patient-specific midfacial features [8,22,25]. Most importantly, these flaps, when dissected and implemented correctly, are associated with positive long-term outcomes [9].…”

Medial Canthal Reconstruction - Scar Restricting Vision in Only Seeing Eye of a 75-year-old Female

“…Regional flaps may be further broken down into different categories: Rhomboid flap 9 , Bilobed Rotational flap 10 , Paramedian Forehead Flap 11 , and V to Y flap 12 . Like the name suggests, a rhomboid flap uses a rhomboid shape for the transposition process.…”