title: A split forehead flap for the treatment of resistant bilateral upper and lower eyelid ectropion postburn injury.
abstract: OBJECTIVE
  The aim of this surgical procedure was to definitively correct severe recurrent upper and lower bilateral eyelid ectropion after 2 attempts with full-thickness skin grafts. It was necessary to repair all 4 eyelids with forehead skin. Middle lamella support was required.
  
  
  METHODS
  Bilateral median forehead flaps, which were well vascularized by the supratrochlear vessels, were chosen for this procedure to utilize the readily available forehead tissue. The median forehead flap can be easily positioned to cover the entire eyelid. Furthermore, the flap could be split in half, without the risk of vascular compromise. Middle lamella support was provided with a cartilage graft from the nasal septum.
  
  
  RESULTS
  At 4 months, the patient no longer suffered from exposure keratopathy and both forehead flaps had healed well. At 12 months, the functional and cosmetic outcomes of this procedure were acceptable.
  
  
  CONCLUSIONS
  This method of surgery can be effective in the young, in whom the Mustarde cheek advancement fails, or when there is little available unburnt tissue. It can be used as an alternative to a forehead flap when both upper and lower eyelids are damaged bilaterally. The split forehead flap definitively corrected the ectropion in this case.
authors.affiliation: Severe Burn Injury Unit, Royal North Shore Hospital, Pacific Highway, St Leonards 2065, New South Wales, Australia.
authors.forename: Lara
authors.initials: L
authors.lastname: Wetton
authors.forename: Aruna
authors.initials: A
authors.lastname: Wijewardena
authors.forename: Michael
authors.initials: M
authors.lastname: Miroshnik
authors.forename: John
authors.initials: J
authors.lastname: Vandervord