Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction
Purpose:. The paramedian forehead flap, while initially used for reconstruction of nasal defects, has been adapted for repair of anatomical subunits in the medial canthal and eyelid area. A significant obstacle for utilizing the flap has been the bulky, unsightly vascular pedicle that is maintained...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-04-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004223 |
| _version_ | 1828349142025371648 |
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| author | Wesley L. Brundridge, DO Dimitrios N. Sismanis, MD Adam H. Altman, MD Christopher M. DeBacker, MD, FACS David E.E. Holck, MD, FACS |
| author_facet | Wesley L. Brundridge, DO Dimitrios N. Sismanis, MD Adam H. Altman, MD Christopher M. DeBacker, MD, FACS David E.E. Holck, MD, FACS |
| author_sort | Wesley L. Brundridge, DO |
| collection | DOAJ |
| description | Purpose:. The paramedian forehead flap, while initially used for reconstruction of nasal defects, has been adapted for repair of anatomical subunits in the medial canthal and eyelid area. A significant obstacle for utilizing the flap has been the bulky, unsightly vascular pedicle that is maintained between surgical stages. We describe our surgical experience using the tunneled variation in a single stage procedure.
Methods:. A retrospective chart review was performed of three surgeons’ charts over a 5-year period. All patients who underwent the tunneled paramedian forehead flap variation were selected. Outcomes measured included underlying pathology, Mohs defect area and depth, and canalicular involvement.
Results:. A total of 20 tunneled flaps were performed after successful Mohs excision of cutaneous malignancies. The average Mohs defect surface area was 13.57 cm2 with depth down to periosteum (n = 13), bone (n = 5), or orbital fat (n = 2). Five patients had full-thickness eyelid defects (25%), and nine (45%) had canalicular defects. The overall complication rate for this study was low with no flap failure. Two patients (10%) desired thinning of the subcutaneous flap for improved cosmesis, and one patient (5%) required further eyelid revision due to the complexity of the initial Mohs defect. The remaining 17 patients required no further surgical procedures.
Conclusion:. The tunneled paramedian forehead flap is a useful technique for medial canthal and eyelid reconstruction. This technique allows reconstruction of a challenging area. Complication rates are low, and this tunneled variation provides a single stage variation to the traditional multistage forehead pedicle flap. |
| first_indexed | 2024-04-14T01:05:22Z |
| format | Article |
| id | doaj.art-5380f12f548642558dc7eb2a8053b788 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-14T01:05:22Z |
| publishDate | 2022-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-5380f12f548642558dc7eb2a8053b7882022-12-22T02:21:16ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-04-01104e422310.1097/GOX.0000000000004223202204000-00048Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid ReconstructionWesley L. Brundridge, DO0Dimitrios N. Sismanis, MD1Adam H. Altman, MD2Christopher M. DeBacker, MD, FACS3David E.E. Holck, MD, FACS4From * Eyeplastx, Oculofacial Plastic and Reconstructive Surgery, San Antonio, Tex.From * Eyeplastx, Oculofacial Plastic and Reconstructive Surgery, San Antonio, Tex.§ 59th Medical Wing, Department of Ophthalmology, San Antonio, Tex.From * Eyeplastx, Oculofacial Plastic and Reconstructive Surgery, San Antonio, Tex.From * Eyeplastx, Oculofacial Plastic and Reconstructive Surgery, San Antonio, Tex.Purpose:. The paramedian forehead flap, while initially used for reconstruction of nasal defects, has been adapted for repair of anatomical subunits in the medial canthal and eyelid area. A significant obstacle for utilizing the flap has been the bulky, unsightly vascular pedicle that is maintained between surgical stages. We describe our surgical experience using the tunneled variation in a single stage procedure. Methods:. A retrospective chart review was performed of three surgeons’ charts over a 5-year period. All patients who underwent the tunneled paramedian forehead flap variation were selected. Outcomes measured included underlying pathology, Mohs defect area and depth, and canalicular involvement. Results:. A total of 20 tunneled flaps were performed after successful Mohs excision of cutaneous malignancies. The average Mohs defect surface area was 13.57 cm2 with depth down to periosteum (n = 13), bone (n = 5), or orbital fat (n = 2). Five patients had full-thickness eyelid defects (25%), and nine (45%) had canalicular defects. The overall complication rate for this study was low with no flap failure. Two patients (10%) desired thinning of the subcutaneous flap for improved cosmesis, and one patient (5%) required further eyelid revision due to the complexity of the initial Mohs defect. The remaining 17 patients required no further surgical procedures. Conclusion:. The tunneled paramedian forehead flap is a useful technique for medial canthal and eyelid reconstruction. This technique allows reconstruction of a challenging area. Complication rates are low, and this tunneled variation provides a single stage variation to the traditional multistage forehead pedicle flap.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004223 |
| spellingShingle | Wesley L. Brundridge, DO Dimitrios N. Sismanis, MD Adam H. Altman, MD Christopher M. DeBacker, MD, FACS David E.E. Holck, MD, FACS Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction |
| title_full | Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction |
| title_fullStr | Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction |
| title_full_unstemmed | Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction |
| title_short | Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction |
| title_sort | single staged tunneled forehead flap for medial canthal and eyelid reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004223 |
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