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Reconstruction of Extensive Frontal Fracture With Titanium Mesh

When local flap options are not available or suitable, the best choice of regional reconstruction method is the forehead flap. The skin of the forehead has perfect color and tissue match with the nose, lips, as well as the medial canthal and malar regions. Paramedian forehead flap is widely accepted as the workhorse flap for nasal reconstruction. The paramedian forehead flap is an axial flap that is perfused by the supratrochlear artery as major and the supraorbital artery as minor pedicle. Vertical paramedian flap length is limited with hairline. Obliquely oriented flap can be used to increase the length. In our case, local flaps from the malar region were not reliable because of a previously performed surgery. We preferred deepithelialized modification of paramedian forehead flap instead of standard fashion because of the thickness heterogeneity of the cavity. The distal portion of the flap was folded to fill the deeper caudal part of the defect. The fullthickness skin graft obtained from the flap was used to cover the defect. Thus, the cavitary defect was filled and no additional morbidity was formed for skin graft harvesting. Being a 2-stage procedure is the most important disadvantage of forehead flap. The perfect color and tissue match with the infraorbital region makes this disadvantage negligible. With our modification, a cavitary infraorbital defect could be reconstructed, preserving the contour of the cheek and also achieving color and tissue match. Cemil Ozerk Demiralp, MD Department of Plastic Reconstructive and Aesthetic Surgery Ataturk Training and Research Hospital Ankara, Turkey