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Brief Report
June 2018

Assessment of Frontalis Myocutaneous Transposition Flap for Forehead Reconstruction After Mohs Surgery

Author Affiliations
  • 1Department of Dermatology, University Clinic of Navarra, Pamplona, Spain
JAMA Dermatol. 2018;154(6):708-711. doi:10.1001/jamadermatol.2018.1213
Key Points

Question  Does the frontalis myocutaneous transposition flap (FMTF) represent a good alternative for the reconstruction of forehead defects?

Finding  In this case series of 12 patients with large, deep forehead defects secondary to Mohs surgery reconstructed using the FMTF, all had satisfactory cosmetic and functional results and there were no postoperative complications.

Meaning  The FMTF is a useful alternative because it is richly vascularized by the frontalis muscle or its fascia, thus permitting a random design and a long and narrow shape that allows primary closure of the donor site and a 1-stage reconstruction of large forehead defects.


Importance  Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and achieving an excellent cosmetic and functional result is imperative in this location.

Objective  To highlight the utility of a frontalis myocutaneous transposition flap (FMTF) for forehead reconstruction after Mohs surgery.

Design, Setting, and Participants  Surgical technique case series including 12 patients with large forehead defects recruited between January 2010 and June 2017 at the Dermatology Department of the University Clinic of Navarra, Spain. All patients underwent Mohs micrographic surgery for skin cancer (5 basal cell carcinomas, 4 melanomas, 2 squamous cell carcinomas, and 1 adnexal tumor) located on the forehead (8 paramedian, 2 midline, and 2 lateral subunits) resulting in defects ranging from 9 to 28 cm2 in size.

Intervention  Mohs micrographic surgery followed by FMTF. Taking into account the defect’s size and location, a lateral lobulated flap is designed with an inferior pedicle and incision lines are made vertically to the hairline containing part of the frontalis muscle or its fascia. The flap swings into the primary defect and direct closure of the donor site is achieved. Additional corrections for removing skin folds or a guitar-string suture can be made.

Main Outcomes and Measures  Absence of acute complications and achievement of high aesthetic and functional goals in postoperative follow-up.

Results  Satisfactory cosmetic and functional results were achieved for all 12 patients (7 men and 5 women; mean age, 62.7 years [range, 47-86 years]) and there were no postoperative complications. All the myocutaneous flaps survived without any acute complications, such as episodes of local bleeding, infection, flap margin necrosis, or congestion. Postoperative follow-up ranged from 6 months to 3 years. No patient needed scar revision. Six patients presented with paresthesia in areas of the forehead and scalp. Sensory recovery tended to improve over time, and paresthesia gradually decreased, disappearing in 5 of 6 cases after 12 months. In 3 patients there was a minimal hair transposition that required laser treatment.

Conclusions and Relevance  The FMTF provides a simple method for 1-stage reconstruction of large forehead defects as an alternative to classic advancement flaps.

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