Burow's Wedge Advancement Flap for Lateral Forehead Defects

Dermatologic Surgery, 2004

Journal of The European Academy of Dermatology and Venereology, 2006

Background Full-thickness skin grafts are an important tissue source for reconstructive surgery. Burow's grafts are full-thickness skin grafts that use adjacent lax skin as the donor site. This technique has also been referred to as island grafts, dog-ear grafts or adjacent-tissue skin grafts.Objective The objective was to describe the technique of Burow's grafts for reconstruction of facial defects taking account of its benefits and limitations.Methods The operative technique is simple: after a circular excision of the cutaneous lesion, we enlarged the excision line (towards one or both sides of the defect) following the relaxed tension lines. We created a secondary triangular defect by excising skin that is then used for the graft (as donor site). After adequate undermining, we proceeded to direct linear closure of this secondary defect. Finally, the graft was placed and sutured in the remaining defect.Results The proximity of the donor site provides an excellent tissue match because colour, hair density, texture, sebaceous features and thickness are similar to the recipient site. A good cosmetic result is therefore ensured.Conclusion Burow's grafts can be a good choice for reconstruction of extensive facial surgical defects because of aesthetic results. In addition, it is a simple technique that can be performed in one sole surgical act, with local anaesthesia and without changing the operative site.

Dermatologic Surgery, 2019

A n 84-year-old woman presented with a basal cell carcinoma located on the right lateral forehead and temple region. After discussion of various treatment approaches, she elected to proceed with Mohs micrographic surgery. Negative margins were achieved after 5 stages, and the resultant defect measured 4.1 • 2.2 cm with extension to the right anterior temple and right lateral eyebrow (Figure 1). How would you repair this defect? Figure 1. Defect after 5 Mohs stages measuring 4.1 • 2.2 cm.

Dermatologic Surgery, 2006

Plastic and Reconstructive Surgery, 2007

Background: Central forehead defects are difficult for the plastic surgeon. Constraints include tissue match, hair-bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominent location. Tissue expansion requires multiple operations and weeks of expansion. Local flaps result in added scars to the cosmetically sensitive forehead region. However, the forehead also provides consistent patterns of rhytides that can be used to camouflage local flap scars. This article describes a local flap for reconstructing central forehead skin defects that achieves tissue coverage with a cosmetically appealing result. Methods: Six patients with central forehead cutaneous malignancies were reviewed; their defects were too large to close primarily. The defects were closed using bilateral periglabellar local advancement flaps with Burow's triangles, with scars in the natural skin creases of the aging forehead. The superior triangles were oriented horizontally, which placed incisions within the frontalis muscle forehead creases. The inferior triangles were oriented obliquely within skin creases of the corrugator muscles. Central vertical incisions remained and blended inconspicuously into the aging forehead. Results: Five patients with central forehead melanomas and one patient with Mohs' defects after excision of basal cell carcinoma were referred by their dermatologists (age range, 60 to 83 years; mean, 72 years). Defects ranged from 2.1 to 5.3 cm in greatest diameter (mean, 3.7 cm). All were closed with the periglabellar flap. One minor complication of hematoma was treated with aspiration in the office. All six patients were satisfied with the results of their reconstruction. Conclusion: For central forehead skin defects up to 5 cm in diameter, the periglabellar flap offers a reconstructive option that uses local tissue and hides scars within natural forehead wrinkles, providing an aesthetically pleasing result.

Dermatologic Surgery, 2008

Dermatologic Surgery, 2017

Dermatologic Surgery, 2004

BACKGROUND. Reconstruction of cutaneous eyebrow defects is a challenge, as eyebrow positioning provides an important role in communication, cosmesis, and signaling age, gender, and emotional status. Special consideration must be paid in order to maintain eyebrow symmetry and to avoid distortion of the hairline. OBJECTIVE. To demonstrate reconstructive options for the eyebrow that preserve maximal function and cosmesis. METHODS. The anatomy and function of the eyebrow are reviewed. Descriptions of five techniques of eyebrow reconstruction are then presented, including specific limitations and benefits of each closure option. Pertinent details regarding flap mechanics, design, and patient selection are also included.

Dermatologic Surgery, 2006

Dermatologic Surgery, 2005