PROCEDURE: Reconstruction of left upper forehead defect with almost total forehead and scalp advancement flap with galeal scoring.
CLINICAL HISTORY: This 76-year-old male presented with a rather large 48x29 mm defect, oval in shape, on the left superior forehead and left frontal scalp. Previous scars were noted on the mid vertex scalp, as well as on the left forehead, precluding mobile skin.
OPERATIVE PROCEDURE & FINDINGS: After satisfactory LMA, the areas were infiltrated with 1% Xylocaine with epinephrine and a supraorbital nerve block accomplished. The periosteum was intact beneath the wound, which was oval in shape. Considerable rigidity was noted in the scalp tissues, as well as the left forehead because of previous surgery and scars. A skin graft was considered, but because of the aesthetic defect, a flap reconstruction was elected. Accordingly, an almost total scalp dissection was accomplished above the periosteum, beneath the galea, over to the right ear, and almost back to the occiput. The galea was then scored. Using serial tissue expansion, the mobility was gained of approximately 1.5 cm
In a similar fashion, the entire mid to left forehead, down to the zygoma, was dissected beneath the galea, and again galeal scoring accomplished. The wound edges were advanced and secured with 3-0 Monocryl under considerable tension in the galea. Burrow's triangles were then resected medially and posteriorly to create an S-shaped type of incision measuring 8 cm in length. Finally, the skin was approximated with 3-0 nylon. A small gap was left in the mid portion to avoid excessive tension. This produced an aesthetic result to prevent distortion of the landmarks and depression. Antibiotic ointment and sterile dressings were applied.