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JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. IX, n 1, June 2022

Pages: 1080-1083
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Reconstruction of Half of the Forehead Traumatic Defect with Single Rotation Flap and Hemi-Brow Transposition in a Resource Constrained Setting: A Case Report

Author: Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie

Category: JMSR Surgery

Abstract:

Forehead reconstruction is very challenging due to limited availability of matching skin for coverage. This is even more challenging in acute traumatic events characterized by gross contamination, presence of open wounds and injury to surrounding tissues. The use of loco-regional flap option may be the only available resort where facility and expertise for free flaps are not adequate. We present a 50 year old lady that had traumatic avulsion of slightly over half of the forehead with an extension wound to the ipsi-lateral temporal region following road traffic accident. There were crushing of ipsi-lateral eye and periosteal stripping of the underlying bone. She had an immediate flap cover after resuscitation using a single rotation scalp flap based on the ipsi-lateral occipital, posterior auricular and superficial temporal arteries. The adjoining temporal region wound was covered with split-thickness skin graft. She had excellent flap survival and satisfactory graft take. We observed that this flap could be successfully used in the setting of trauma to transfer a like for skin in the setting of trauma. This is especially useful in resource constrained setting where free tissue transfer is still insufficiently used.

Keywords: Periosteal stripping, Rotational scalp flap reconstruction, Traumatic forehead avulsion

References:

  1. Chritiano JG, Bastidas Nicholas, Langstein HN. Reconstruction of the scalp, calvarium and forehead. In: Thorne CT. Grab and Smith’s Plastic Surgery (7th Ed). Philadelphia, Wolters Kluwer/ Lippincott Williams & Wilkins; 2014:342-350
  2. Wells MD, Skytta Carla. Scalp and forehead reconstruction. In Neligan PC. Plastic Surgery (3rd Ed), Vol 3. Elsevier Saunders, New York; 2013: 105-133
  3. Shores JT, Lee WPA. Management of mutilating injuries of the upper extremity. In: Thorne CT. Grab and Smith’s Plastic Surgery(7th Ed). Philadelphia, Wolters Kluwer/ Lippincott Williams&Wilkins; 2014:833-837.
  4. Mori Stefano, Di Monta Gianluca, Marone Ugo, Chiofalo MG, Caraco Corrado. Half forehead reconstruction with a single rotational flap for dermatofibrosarcoma protuberans treatment. World J Surg Onc 10, 78(2012). https://doi.org/10.1186/1477-7819-10-78
  5. Souza CD. Reconstruction of large scalp and forehead defects following tumor resection: Personal strategy and experience-analysis of 25 cases. Rev Bras Cir Plast.2012;27(2): 227-237
  6. Boustany A,Gharreeb P, McClellan WT. Forehead reconstruction using a modified dual plane A to T flap. Can J Plast Surg.2012 Winter;20(4):251-254. https://doi:10.1177/229255031202000407.
  7. El-Sabbagh AH. Usage of rotational flap coverage of a large central forehead defect. GMS Interdiscip Plast Reconstr Surg DGPW2017;6:Doc02. https://doi.10.3205/iprs000104.
  8. Marks MW, Argenta LC. Principles and applications of tissue expansion. In: Gurtner GC (ed). Plastic surgery(3rd ed), vol 1.New York,Elsevier Saunders;2013:622-653.
  9. Seitz IA, Gottlieb LJ. Reconstruction of scalp and forehead defects. Clin Plast Surg.2009;36:355-377. https://doi.10.1016/j.cps.2009.02.001.
  10. Maduba CC, Nnadozie UU. Successful management of a comatose patient with traumatic brain exposure with a fronto-parieto-occipital flap. Journal of trauma and injury.2020;33(1):48-52. https://doi.org/10.20408/jti.2019.037.