Repair of a Large Forehead Defect

Monk, Edward C

doi:10.1097/dss.0000000000001539

Cited by 1 publication

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Repair options for this patient were carefully considered [6]. Unfortunately, a primary intermediate or complex linear closure was not an option due to her history of wound dehiscence and prior wound edge necrosis due to high tension.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Exposed Frontal Bone Following Mohs Micrographic Surgery

Mj¹,

Em²

2020

J Clin Cosmet Dermatol

View full text Add to dashboard Cite

An 87 year old woman with skin type I/II, history of extensive sun exposure and multiple non melanoma skin cancers was referred to the author's cancer center post excision of an invasive squamous cell carcinoma of the mid superior forehead requiring two Mohs stages to achieve a tumor free plain. Her surgical course was complicated by wound dehiscence with a resulting defect that measured 3.2 × 2.0 cm with exposed bone devoid of periosteum (Figure 1). The patient lived alone and lacked nursing care at home. Repair options were scarce based on her skin atrophy, prior sloughed wound edges due to tension, and limited tissue mobility. A bilobed flap was designed with the axis of the first lobe 90 degrees from the wound and the second lobe on a line 180 degrees with that of the defect allowing recruitment of the only available lax skin (Figure 2).A regional block was achieved by injecting 1-2 ml of 1% lidocaine 17 mm and 27 mm from the glabellar midline bilaterally just above the superior orbital rim exterior to the bony orbital margin corresponding to the location of the exiting supratrochlear and supraorbital nerves, respectively (Figure 1). The first lobe of the bilobed flap was drawn perpendicular and of equal width as the width of exposed bone. The second lobe was drawn 90 degrees from the first lobe and also of the same width (Figure 2). The flap was designed whereas the second lobe recruited the only area of tissue laxity and the resulting tertiary defect could be closed with minor tension. After local anesthetic infiltration, the incision was carried down to the deep subcutaneous layer along the drawn flap outline. The first lobe was rotated approximately 60 degrees onto the defect providing coverage to the exposed frontal bone with minimal dog ear formation (Figure 3). The second lobe was transposed 90 degrees onto the secondary defect. The resulting

show abstract

Section: Discussionmentioning

confidence: 99%