Sunday, October 10, 2004

The Peri-glabellar Flap for Closure of Central Forehead Defects

Craig B. Birgfeld, MD and Benjamin Chang, MD.

Background: Defects of the central forehead create a difficult problem for the plastic surgeon. Constraints of reconstruction include tissue match, hair bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominent location. Tissue expansion requires multiple surgeries and weeks of expansion. A skin graft often does not provide good skin color or thickness match. Local flaps provide the best skin match, but at the expense of added scars to the cosmetically sensitive forehead region. However, the forehead also provides consistent patterns of rhytids which can be utilized to camouflage local flap scars.

Objective: We describe a local flap for reconstructing central forehead skin defects that achieves tissue coverage with a cosmetically appealing result.

Methods: We reviewed 3 patients with central forehead cutaneous malignancies who had defects that were too large to close primarily. The defects were closed with bilateral peri-glabellar (PIG) local advancement flaps and four Burow’s triangles which placed the scars in the natural skin creases of the aging forehead. The superior triangles were oriented horizontally to place incisions within the frontalis muscle forehead creases. The inferior triangles were oriented obliquely to utilize skin creases of the corrugator muscles. A central vertical incision remained which blends inconspicuously into the aging forehead.

Results: Three patients were referred by their dermatologists with either central forehead melanomas (2) or Moh’s defect after excision of basal cell carcinoma (1). Their ages ranged from 73 to 83 (mean = 78.7). Defect size ranged from 2.6 cm to 4.6 cm in diameter (mean = 3.67cm). All were closed with the PIG flap. One minor complication of hematoma was treated with aspiration in the office. All 3 patients were satisfied with the results of their reconstruction.

Conclusion: For central forehead skin defects up to 4 cm in diameter, the Pig Flap offers a reconstructive option, which utilizes local tissue and hides scars within natural forehead wrinkles providing an aesthetically pleasing result.