Repair of large defects in the forehead using a median forehead rotation flap and advancement lateral U-shaped flap

BACKGROUND The forehead is a large and highly expressive and dynamic cosmetic unit. Most forehead defects that cannot be closed primarily are reconstructed with laterally based advancement flaps. OBJECTIVE A combination of median forehead rotation flap and advancement lateral U-shaped flap for repair of medium- to-large-size defects in paramedian and lateral forehead is described. METHODS Technically, the design of median forehead rotation flap based on supratrochlear vessels used here is similar to the median forehead transposition flap used to reconstruct large defects of the nasal dorsum. The length and the movement of the flap are much smaller in this case. Approximately 2/3 of the closure of the defect is achieved by displacing the median forehead flap while the remaining 1/3 corresponds to the advancement of the lateral U-shaped flap. RESULTS The flaps are simple to perform, have minimal complications, and have good cosmetic results. A representative case is presented with photographs. CONCLUSION For selected medium- to large-size horizontal defects in the paramedian and the lateral forehead, the combination of a median forehead rotation flap and an advancement lateral U-shaped flap offers a simple, visually pleasing repair that preserves the forehead architecture.