Reconstruction techniques for forehead defects

The forehead as one of the major aesthetic units of the face presents certain challenges for reconstructive surgeons. These are the followings: a) maintaining the normal boundaries of the unit, specifically the temporal and frontal hairlines, as well as brow symmetry; b) preserving motor nerve and if possible, sensory nerve function; and c) optimal placement of surgical scars (brow, relaxed skin tension lines (RSTL), hairline). Forehead reconstruction is completed with much greater wound tension than other facial sites because of the paucity of available tissue and the proximity and immobility of the underlying structures. Brow elevation is often a problem with many closure options. The brow ist best dealt with as „free margin“ similar to the lip and alar rim. Midline defects can be closed vertically or horizontally. Paramedian forehead defects are ideally closed fusiform in the transverse RSTL. For lager defects, uni or bilateral advancement flaps can be used. There are many reconstructive options for lateral forehead defects. Primary repair using RSTL is the closure of chice. If not appropriate or possible falp repair should be the next consideration. Rotation, advancement and transposition flaps can be developed based on the excess tissues of the temple. Undermining is done with caution because of increased risk for motor nerve damage. Second intention healing or grafts are not a first choice option for significant forehead defects, but may be used for the lateral forehead defects because of its concavity. Here we demonstrate reconstructions of patients with forehead defects.