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West Indian Medical Journal

Print version ISSN 0043-3144

West Indian med. j. vol.58 no.2 Mona Mar. 2009




Use of a combined sliding and rotation flap to close a central forehead defect



L Weatherhead

Division of Dermatology, University of Ottawa, 208-1919 Riverside Drive, Ottawa, Ontario, Canada K1H 5L5





There are many descriptions of cutaneous flaps performed to close forehead defects after the removal of a cutaneous malignancy. The L-Flap incorporates the natural glabellar crease lines as well as the horizontal forehead lines to allow easy movement of the flap as well as producing an excellent cosmetic result.



After marking out the clinically visible margins of the tumour (Fig.1), the design of the flap is made with marking of the zones where the supratrochlear and supra-orbital nerves pass (Fig. 2). The tumour is then excised (Fig. 3) and the flap created (Fig. 4). Care is taken at all stages of the procedure to obtain good visualization, haemostasis and to identify and spare (if possible) underlying structures. After appropriate haemostasis, the flap is shifted medially and closed in layers with absorbable subcutaneous and non-absorbable cutaneous sutures (Fig. 5). After the procedure, appropriate counselling is required especially about bruising and wound care over the immediate postoperative period.












The pictures at one week and three months postoperatively show the result of this procedure (Fig. 6, 7).






The final postoperative picture demonstrates a very good cosmetic end-point for this surgical procedure. This is a very good flap technique for use in this clinical area.



Dr L Weatherhead
Associate Professor and Director of Surgical Dermatology, Division of Dermatology, University of Ottawa
208- 1919 Riverside Drive Ottawa, Ontario Canada K1H 5L5
Fax: 613-230- 4402