Preexpanded Parafrontal Median Flap in the Repair of Pigmented Nevus in the Middle Face: An Effective Approach.

Objective: This clinical study described the application of the preexpanded paramedian frontal flap in the repair of midfacial congenital melanocytic nevus to summarize the aesthetic effects of this facial repair.

Methods: The authors analyzed data from 15 patients (8 males and 7 females) who underwent median facial pigmented nevus repair with a preexpanded parafrontal median flap. The operation was divided into 3 stages as follows: tissue expander implantation under the prefrontal area, the flap with pedicled transfer after nevus removal after 2 to 3 months of expansion, and the vascular pedicle cut as a delayed operation 3 weeks later and then the flap pedicle was severed. Also, the residual pigment nevus was repaired, and the flap pedicle was restored to the forehead. During the follow-up, the necessary flap thinning and hair removal were performed. Demographic information, site and area of nevus, operative procedure, and complications were recorded.

Results: The complications of expander implantation contained hematoma (n = 1) and incision dehiscence (n = 2), but they had no effects on the overall repair after symptomatic treatment. All transferred flaps had good blood supply. Six patients were treated with flap thinning, and 13 cases of distal flaps were treated with laser hair removal. The color, texture, and thickness of the repaired flap were consistent with the facial recipient area with an unobvious surgical scar, no contractures on the middle facial organs and tissues, and no obvious eyebrow displacement.

Conclusion: Preexpanded paramedian frontal flap could be an effective way to repair a large area of midfacial pigmented nevus.