Scalping forehead flap for extranasal reconstructions: total reconstruction of the lower lid

J. M. Converse described the scalping forehead flap in 1942 with the aim of using it in total nasal reconstruction. A rich net of arterial and venous vessels constitute the basic pattern of its blood supply through three principal pedicles: (1) temporal superficial, (2) supraorbital, and (3) supratrochlear. It was described for nasal reconstruction, but due to its characteristics, such as color of the frontal skin, texture, hairless skin, and reliable irrigation, it can be used in the reconstruction of other facial areas. According to these particularities, the Converse flap was used in the reconstruction of a total left lower lid and adjacent lateral nose and cheek areas in a patient with an extended squamous carcinoma. The tumoral resection included the removal of (1) complete lower lid, (2) lacrimal lower canaliculus, sac, and nasolacrimal duct, (3) lower ocular conjunctiva, (4) intraorbitary fat and both inferior oblique and inferior rectus muscles, and (5) adjacent skin of the nose and cheek. Postoperative controls showed an excellent aesthetic and functional result. A hypochromic frontal skin graft was the only sequela; definitive skin coloration was obtained by a dermopigmentation technique. The versatility of this forehead flap allows it to be successfully used for reconstruction not only in the nasal area but also in other facial ones.