Aesthetic full-perioral reconstruction of burn scar by using a bilateral-pedicled expanded forehead flap

Perioral scar after burn usually not only results in the certain degree of functional loss of the mouth, but it also destroys the facial appearance. This study aims to restore the perioral scarring lesion after burn as a whole unit to be achieved the functional and cosmetic outcomes in this area, by using a bilateral-pedicled expanded forehead flap with minimal donor morbidity. Six patients with perioral burn scar were undergoing the treatment. The technique was carried out by first positioning a tissue expander in the forehead pocket under the frontalis of the forehead and serially inflating it in about a 6 to 8-week period. An expanded forehead flap was then designed partially from the frontal hairline by basing on the bilateral temporal scalp pedicles including in the frontal branches of the superficial temporal arteries. Thereafter, a transverse incision was also made in the flap at the planned mouth position to have the mouth open. The flap was then raised and transferred into the recipient site after the perioral scar was excised. The forehead donor site was directly closed into the frontal hairline with the remained expanded forehead tissue. The temporal donor sites were temporarily covered with the grafted scarring skin from the recipient site. About 3 to 4 weeks after the operation, the bilateral pedicles were cut off and return to the temporal sites after the lesion were prepared. With our experiences in 6 patients using the flap for full-perioral lesion repair, the flap could be formed as big as 12 x 25 cm across the midline of the forehead without flap necrosis and the problem of the forehead donor site closure. All of the patients showed esthetic and functional results in the perioral area and good donor acceptability with minimal donor morbidity. The results indicate that the above-mentioned flap can not only be a safe, ample, and color-matched flap for full-perioral reconstruction, but it could also diminish the donor morbidity to minimum.