Double-Opposing Rotation-Advancement Flaps for Closure of Forehead Defects

Objective  To describe a local flap for closure of forehead defects of all sizes that does not alter the brow position or hairline.

Methods  Retrospective review of 16 cases in which the double-opposing rotation-advancement flaps were used for closure of small (<10 cm²), medium (10-20 cm²), and large (>20 cm²) forehead defects. This technique was developed from Orticochea's method for closure of large scalp wounds.

Results  All 16 patients underwent single-stage closure of forehead defects using our design. Six patients were men, 8 were women (mean age, 71 years). Preoperative defect sizes ranged from 3 to 30 cm² (mean, 18 cm²). All wounds resulted from Mohs surgery for cutaneous malignant neoplasms; 2 were adjacent to previous reconstructions. No recurrence of tumor was seen during the study period. No permanent frontal branch injuries occurred. One patient developed a moderate cellulitis. Photographic analysis showed that brow position and hairline contour were maintained in all cases.

Conclusions  The double-opposing rotation-advancement flap closure is a versatile reconstructive option for small, medium, and large forehead defects. The technique involves elevation of opposing, asymmetric flaps, with subsequent rotation of one side and advancement of the contralateral side. Single-stage closure may be accomplished without unappealing changes to the brow position or hairline.