This series of large forehead defects features a frequent common theme of reconstruction. The goal of reconstruction is protection of eyebrow position and prevention of upper eyelid retraction. If tension was placed on the eyebrow with a large forehead flap, upper eyelid can suffer from a cicatricial lagophthalmos. Incomplete closure of the eyelid of course creates significant functional impairment for the patient. Prevention of this complication, utilizes a contralateral paramedian forehead flap transposed 90 degrees to control the position of the eyebrow and eyelid. In one case, we utilized a small nasal glabella myocutaneous island flap transposition to the medial eyebrow to prevent its retraction.
Another reconstructive principle of large forehead defect reconstruction includes the two sources of reconstructive blood supply. The first is the supraorbital vascular bundle utilized in forehead flaps. The second is the superficial temporal artery blood supply provided via that superficial temporoparietal fascia. Cutaneous islands supplied by this fascia and the superficial temporal artery are an excellent versatile source of reconstruction of these defects.