Tomás-Velázquez A, et al. - Researchers highlighted the utility of a frontalis myocutaneous transposition flap (FMTF) for forehead reconstruction after Mohs surgery. As an alternative to classic advancement flaps, a simple method for 1-stage reconstruction of large forehead defects was provided with the FMTF.

Methods

• Experts included surgical technique case series including 12 patients with large forehead defects recruited between January 2010 and June 2017 at the Dermatology Department of the University Clinic of Navarra, Spain.
• Mohs micrographic surgery was conducted in all patients skin cancer (5 basal cell carcinomas, 4 melanomas, 2 squamous cell carcinomas, and 1 adnexal tumor) located on the forehead (8 paramedian, 2 midline, and 2 lateral subunits) resulting in defects ranging from 9 to 28 cm²in size.
• The main intervention was Mohs micrographic surgery followed by FMTF.
• Considering the defect’s size and location, a lateral lobulated flap was designed with an inferior pedicle and incision lines were made vertically to the hairline containing part of the frontalis muscle or its fascia.
• Direct closure of the donor site was achieved with the flap swinging into the primary defect.
• For removing skin folds or a guitar-string suture additional corrections can be made.
• Main Outcomes and Measures were the absence of acute complications and achievement of high aesthetic and functional goals in postoperative follow-up.

Results

• Findings suggested that for all 12 patients (7 men and 5 women; mean age, 62.7 years [range, 47-86 years]) satisfactory cosmetic and functional results were achieved and there were no postoperative complications.
• As per data, without any acute complications, such as episodes of local bleeding, infection, flap margin necrosis, or congestion, satisfactory cosmetic and functional results were achieved.
• Findings suggested that postoperative follow-up ranged from 6 months to 3 years.
• Scar revision was not required by any patient.
• Paresthesia in areas of the forehead and scalp was seen in 6 patients.
• Over time, a tendency towards improvement was shown by sensory recovery and paresthesia gradually decreased, disappearing in 5 of 6 cases after 12 months.
• Researchers noted a minimal hair transposition in 3 patients that required laser treatment.