Combining Rotation and V-Y Design for Lower Forehead and Temporal Region Reconstruction With Myocutaneous Frontal Flap: Our Experience on 27 Consecutive Cases.

Abstract

Because of direct sun exposure, lower forehead and temporal area are anatomical regions with frequently observed skin tumors. The resulting defects after oncological ablations are usually treated, especially in older patients, by split thickness skin grafting or A-to-T and O-to-T flaps if facing small defects. On specific sites that expose bone or periosteum as well as when a skin graft is best avoided for cosmetic reasons, alternative reconstructive procedures should be considered. An excellent option is the use of myocutaneous frontal flap with rotation and V-Y design, which provide a reliable coverage of defects especially of the temporal area, dispensing appropriate like-tissue by its wide arc of rotation. Between 2010 and 2019, 27 patients underwent myocutaneous frontal flap with rotation and V-Y design reconstruction of medium-to-large-sized soft-tissue defects of the lower forehead and temporal area after tumor excision. The malignant skin lesions involved were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 9), and melanoma (n = 1). Twenty one patients were male, and 6 were female with an average age of 64 (54-86) years. All defects were successfully resurfaced with no local recurrences. The authors present a modification to myocutaneous frontal flap harvesting, with emphasis on its extensive arc of rotation with a V-Y design to minimize donor-site morbidity. The advantages of myocutaneous frontal flap with rotation and V-Y design include a good contour with excellent color, texture, and thickness match and good to excellent aesthetic results.