Use of the bipedicled scalp flap for forehead reconstruction.

Surgical defects following Mohs surgery can present challenging reconstructive problems. Defect size, shape, and depth cannot be predetermined; and consequently, repairs cannot be preplanned. As a result, the reconstructive surgeon, when designing a cosmetic repair, has to be both ingenious and resourceful. Multiple factors must be considered, including lines of minimal tension, innervation, vascularity, tissue movability, and elasticity. Skin of the upper forehead and scalp, although movable, is as elastic as other facial skin, for example, the cheek. Due to the inherent inelasticity of this skin, closure of forehead defects can require a great deal of tissue movement in order to minimize tension along the suture line. Suture lines running contrary to normal skin lines as a result of rotation or transposition flaps may result in poor cosmetic scars. Although several options for repair of forehead defects exist, we have found this flap to be simple and useful. The forehead-releasing incision creates a bipedicle advancement flap designed to (1) create movable forehead and scalp skin, (2) maintain an excellent blood supply, (3) create a secondary defect that can be hidden well within the hairline of the scalp, and (4) allow for a linear closure of the primary defect within or paralleling existing skin lines. A series of three cases is reported.