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Hairline reconstruction utilizing modified winged V-plastic hair-bearing flaps and focal anastomotic line excisions
1Department of Dermatology, University of California, San Francisco, USA.
Background:
A large, recurrent basal cell carcinoma involving the left forehead and suprajacent hair-bearing scalp was excised, following which an esthetically acceptable reconstruction of the scalp and hairline margin was accomplished.
Objective:
A method of utilizing two hair-bearing flaps to cover a large defect at the hair-bearing scalp margin will be photographically demonstrated, and the maneuvers to precisely reconstruct the scalp's anastomotic margin with the forehead will be shown and discussed.
Methods:
Dual hair-bearing "winged" V-plastic flaps were evolved anteriorly, the two flaps joined, an M-plasty (Webster) was then incorporated to spare hair-bearing scalp posteriorly, and the entire conjoined scalp flap then advanced anteriorly to the forehead. The precise curvatures of the anastomotic line were reestablished by exact excisions of forehead skin underlying the hair-bearing scalp flaps, or amputations of overlying hair-bearing scalp in excess of forehead needs.
Results:
An esthetically pleasing and reasonably exact reconstruction of the hair-bearing scalp and forehead anastomotic line was accomplished.
Conclusion:
A precise reconstruction of the forehead/scalp margin can be accomplished utilizing a combination of techniques, including hair-bearing "winged" V-plastic flaps, an M-plasty, and the serial removal of segments of both glabrous and nonglabrous skin to reestablish the frontal hairline margin.