The Transfer of Expanded Forehead Superthin Flap Without Frontalis and Less Hair Follicles Pedicled by Superficial Temporal Vessels

Abstract

Background The expanded forehead flap pedicled with superficial temporal vessel(s) is a common method to treat facial scar deformity. However, local bulkiness and hair retention have limited the use of this flap. Methods Five cadavers were used for anatomy to confirm the forehead “safety zone.” A retrospective study was performed on 15 patients with facial scar deformity who were undergoing the expanded forehead superthin flap (without the expanded capsule, frontalis muscle, and with less hair follicles) pedicled with superficial temporal vessel(s) to transfer and repair the deformity. Results Through cadaver anatomy, the range where the subdermal vascular network laid superficial to the hair follicle level was named the “safety zone,” whose average distance between the bilateral penetrating points was 10.2 cm (8.7–11.6 cm). Fifteen patients with facial scar deformity were treated with the superthin flap technique. The trimming size of the safety zone flap was (6–10) × (12–20) cm. The median time of thinning the safety zone was 35 minutes (range, 25–40 minutes). All flaps healed well. The median residual ratio of the hair follicle was 39.8% (29.9%–50.5%). All patients were satisfied with the contour of the flap. Conclusion We firstly proposed a concept of forehead safety zone and used the superthin flap without the frontalis muscle and less hair follicles to treat facial scar deformity, and obtained an improved therapeutic effect. We think this is an appealing technique that can manifest facial concave and convex in the fine part, improve compliance of the flap, and reduce the times of laser hair removal.