A systematic approach to primary closure of the donor site following transposition of vertical forehead flaps

Summary 20 patients who underwent transposition of a vertical forehead flap for defects of the middle third of the face over a 30 month period are reported and evaluated by the authors. On the basis of the width of the secondary forehead defect, the best technique of direct closure was determined. More simple cases were resolved by careful application of basic techniques of plastic surgery (i.e. undermining, scalp flap rotation). When a forehead defect of more than 4.5 cm in width is expected, previous forehead skin expansion seemed advisable. The results are presented and evaluated. Primary, tension-free closure of the forehead defect was achieved in every case, thus significantly improving the aesthetic result of the operation.