Upper forehead skin reconstruction with H-flap

Abstract

Introduction:There are several options for forehead defect's reconstructions, including different local flaps, regional flaps, free flaps and skin grafts. We used double opposing rectangular advancement flaps (H-flap) in the upper forehead defects.Materials and Methods:This is a prospective case series study that has done in Plastic surgery ward. Of the 10 patients, six were women and four were men, their median age was 61 years (range 50-79 years). Mean follow-up of patients were 15 months and there was no recurrence during this time. We reconstructed forehead after excision of tumours in the same operation.Results:Aesthetic results of H-flap in all cases were great with patient satisfaction according to questionnaire sheets.Conclusion:This local flap is a reliable and safe way for upper forehead defects up to 6 cm lengths. Long-term follow up showed inconspicuous scars and good texture and colour match of the reconstructed forehead. We recommend this flap for upper forehead reconstruction in defects between 4 cm and 6 cm. Directions of incisions are parallel to resting skin tension line and length to width of flap considered 2:1 with excision of burrow triangle from both side. We used silicon sheet post operatively for 3 months for better aesthetic results.

Ultrathin Supratrochlear Artery Cutaneous Branch Flaps for Large Defects Around Eyebrows

“…Although closure is much easier in the vertical (sagittal) than the horizontal (coronal) plane, transforming the longitudinal tension into transverse tension could reduce the risk of eyebrow distortion and facial asymmetry, like the H flap, especially for paramedian forehead defects. 20 Skin grafting is not often used because of the possibility of postoperative contraction, pigmentation, and surface depression. The surgical complexity of the perforator flap and the free flap is high, so they are often used to repair huge complex defects.…”

Reconstruction of a Large Central Forehead Defect

“…However, skin grafts are not suitable for defects extending to the bone, and advancement flaps for large defects on the front may have limited indications. Ebraimi and colleagues 1 presented several cases demonstrating repair by an H flap, but none of the defects were greater than 2.5 cm in size. A-to-T flaps are useful for lateral frontal defects where one part of the flap can be harvested from the temple, allowing for more advancement; however, this approach is less suitable for large mid-frontal defects.…”

Forehead Defects Reconstruction Using Double Opposing Rotation Advancement Flaps

“…These flaps uses local tissue and is also reliable but is limited the defects having size up to 6 cm. 8 Skin grafts are useful to cover larger defects, but colour matching and depth irregularities makes them as last option. Dual plane A to T flap technique is good option as it can cover larger defects.…”