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

Abstract

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.

Minimalistic reconstruction of exposed skull in a complex craniovertebral polytrauma

“…A wide flap-base with extensive dissection and undermining is necessary to preserve vascularity to the flap-edges. [3,10] Free tissue transfers, especially from the radial forearm and anterolateral thigh, are effective choices as well, utilizing superficial temporal artery and vein as recipient vessels. [9] Fenestrations over the outer layer of exposed skull bones until punctate bleeding is visualized from the underlying diploe results in granulation tissue coverage of the bones, followed by thin split-skin grafting later.…”

“…While performing loco-regional flaps and free tissue transfers, rotating and positioning the headneck junction are imperative several times to facilitate flap transfer and suturing. [3,10] ese requirements contradict the primary objective of minimizing neck movements in patients with acute cervical spinal cord injury. [5] Managing the airway properly for during general anesthesia becomes remains critically important in these patients.…”

Life-Threatening Panfacial Wild Dog Bites in a Child

“…14 Scalp and forehead are relatively tough tissues, and a limited triple-plane dissection helps in meticulous repair of injuries over these areas. 7 Over the cheeks and lower face, a deep-plane cervicofacial flap-like approach is helpful. 15 Mobilizing the mauled and avulsed segments of facial soft tissues as a large and thick augmented facial flap ensures adequate vascularity to the wound edges while avoiding undue dissection of the adjacent healthy areas.…”

“…Soft tissues were meticulously apposed following the principles of wound closure with triple-plane dissection over the forehead and deep-plane augmented facial flaps over the mid and lower face. 7,8 To preserve facial symmetry and harmony, reconstruction of the face progressed from central to peripheral with several tension-free synthetic sutures that were loose enough to allow free drainage from deep tissues, while avoiding excessive soft-tissue dissection (Figure 3A and B). Necrosed areas over the right ear were debrided, and remaining ear flaps were satisfactorily juxtaposed to remold the mutilated ear (Figure 3C).…”

Augmented facelift flap for aesthetic reconstruction of posttraumatic facial defects

“…Earlier, significant-sized flaps combining forehead and scalp tissues were performed for reconstructing large forehead defects. Effective reconstruction with minimal complications and good patient-reported outcomes were observed [21]. A similar approach over the face necessitated raising large and thick facial flaps even for smaller defects.…”