Reconstruction of Complex Orbital and Midfacial Defects Using the Converse Scalping Forehead Flap.

Abstract

The achievement of satisfactory functional and aesthetic results with sufficient defect coverage and tension-free closure following massive oncological resection of the head and neck region remains a constant challenge to the reconstructive surgeon. The scalping forehead flap provides generous tissue volume with a robust blood supply needed to reconstruct such defects. In this case series, we reviewed 8 consecutive patients who underwent complex midfacial and orbital reconstructions using the scalping forehead flap due to the wide local excisions of various carcinomas. The donor site defect on the forehead was managed using a split-thickness graft. To reduce anesthetic burden, the second stage was done under local anesthesia. The scalping forehead flap provided sufficient tissue along with a robust axial blood supply that was useful in closing the residual defects after oncological resection with a skin color and texture that matched the surrounding facial tissue, with no signs of marginal necrosis, pedicle thrombosis, or infection. The classic Converse scalping forehead flap remains an invaluable option in the modern era. It successfully achieves secure, tension-free closure for aggressive malignancies with long-term aesthetic and functional outcomes.