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National Journal of Maxillofacial Surgery
 
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LETTER TO EDITOR
Year : 2012  |  Volume : 3  |  Issue : 2  |  Page : 241-242  

Split paramedian forehead flap for medial canthal reconstruction


Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Date of Web Publication4-May-2013

Correspondence Address:
Arvind Krishnamurthy
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.111399

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How to cite this article:
Krishnamurthy A. Split paramedian forehead flap for medial canthal reconstruction. Natl J Maxillofac Surg 2012;3:241-2

How to cite this URL:
Krishnamurthy A. Split paramedian forehead flap for medial canthal reconstruction. Natl J Maxillofac Surg [serial online] 2012 [cited 2019 Dec 16];3:241-2. Available from: http://www.njms.in/text.asp?2012/3/2/241/111399

Sir,

Reconstruction of the eyelids, especially the large full thickness defects, is one of the greatest challenges faced by the head and neck surgeons. A wide range of surgical approaches are used to repair the eyelids depending on the size, location, and extent of defect. [1],[2],[3],[4] The aim of reconstruction of any eyelid defect is to supply a stable movable lid ensuring adequate corneal protection and at the same time providing a good aesthetic quality at the donor site. We present an interesting case in which we split the paramedian forehead flap, thus providing two axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures following resection of basal cell carcinoma of the right medial canthal area.

A 74-year-old man presented to us with a complaint of an asymptomatic ulcer located in the right medial canthus and the adjoining fronto-nasal region for a year [Figure 1]. The 3 × 2 cm ulcer was of insidious onset and gradually increased in size; it was well demarcated and had a black pigmented crusted surface. His visual acuity and eyelid movements were normal. The family history, physical examination of the draining lymph nodes, and other organ systems were unremarkable. An incisional biopsy from the lesion was suggestive of a basal cell carcinoma. Surgical resection of the lesion was performed with 5-mm margin including the lacrimal apparatus [Figure 2]a and b. A left-sided supratrochlear and supraorbital artery-based paramedian split forehead island flap was elevated and transferred to the defect. The donor site was closed primarily. The final histopathology confirmed the lesion as a basal cell carcinoma with tumor-free margins. Except for mild epiphora of the right eye, the patient is disease free over about a year post surgery.
Figure 1: Clinical photograph of the patient (a) Prior to surgery (b) 2 months post surgery showing a satisfactory result

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Figure 2: Intraoperative photographs of the patient showing (a) Resultant defect following wide excision (b) Marking of the split paramedian forehead flap

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Composite reconstruction of medial canthal defects is technically challenging because of the highly specialized anatomy and function of the lids. Local advancement flaps of either the anterior or posterior lamella are not suitable for such complex reconstructions because of the limited amount of adjacent tissues and the limited arc for rotation. Median or paramedian forehead flaps and its modifications have been widely used to reconstruct the nasal and medial canthal areas and are still versatile tools for the reconstruction of the fronto-nasal area. [1],[2],[3],[4] The split paramedian forehead flap is one such modification. The advantages of split paramedian forehead flap are a wider arc of rotation and suitability of splitting due to the axial vascularity. The donor site can be primarily closed without a marked scar. A potential disadvantage of using the forehead flap is the bulkiness of the flap; this could be overcome by careful perioperative debulking of theflap. We found split forehead flap to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects, a satisfactory result can be obtained both functionally and cosmetically.

 
   References Top

1.Sakai S, Soeda S, Matsukawa A. Refinements of the island median forehead flap for reconstruction of the medial canthal area. J Dermatol Surg Oncol 1989;15:524-30.  Back to cited text no. 1
    
2.Chiarelli A, Forcignanò R, Boatto D, Zuliani F, Bisazza S. Reconstruction of the inner canthus region with a forehead muscle flap: A report on three cases. Br J Plast Surg 2001;54:248-52.  Back to cited text no. 2
    
3.Turgut G, Ozcan A, Yeþiloðlu N, Baþ L. A new glabellar flap modification for the reconstruction of medial canthal and nasal dorsal defects: "Flap in flap" technique. J Craniofac Surg 2009;20:198-200.  Back to cited text no. 3
    
4.Cöloðlu H, Koçer U, Oruç M, Sahin B, Ozdemir R. Axial bilobed superficial temporal artery island flap (tulip flap): Reconstruction of combined defects of the lateral canthus including the lower and upper eyelids. Plast Reconstr Surg 2007;119:2080-7.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]


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2 Paramedian Forehead Flap
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