Effects on perfusion by stretching and rotation of forehead skin flaps, as measured by laser speckle contrast imaging.

Purpose: Flaps are used for repair of defects after tumor excision and often need stretching and rotating to cover the defects. Manipulation of flaps may affect blood perfusion, which is crucial for healing. The aim was to examine the impact on perfusion by stretching and rotating forehead skin flaps.

Methods: Blood perfusion was monitored using laser speckle contrast imaging in 19 flaps, raised as part of a direct brow lift. Perfusion was measured before and after stretching (1 and 2 N), and after 90° rotation.

Results: Perfusion decreased along the flap, reaching a minimum plateau at 13 mm (IQR: 9 mm to 19 mm) from the base. Stretching with 1 N resulted in significant reduction of this distance to 9 mm (IQR: 8 mm to 12 mm, p < 0.01). Rotation (90°) did not significantly affect the perfusion. However, stretching the already rotated flap by 1 N reduced the distance to the minimum plateau to 10 mm (7-13 mm, p < 0.05).

Conclusions: Perfusion in forehead skin flaps was significantly reduced when stretched. Rotation of flaps did not affect the perfusion. The effects of stretching may be taken into consideration when performing surgery in the periocular area, particularly in cases with impaired microvascular circulation.