title: Double-opposing rotation-advancement flaps for closure of forehead defects.
abstract: OBJECTIVE
  To describe a local flap for closure of forehead defects of all sizes that does not alter the brow position or hairline.
  
  
  METHODS
  Retrospective review of 16 cases in which the double-opposing rotation-advancement flaps were used for closure of small (<10 cm2), medium (10-20 cm2), and large (>20 cm2) forehead defects. This technique was developed from Orticochea's method for closure of large scalp wounds.
  
  
  RESULTS
  All 16 patients underwent single-stage closure of forehead defects using our design. Six patients were men, 8 were women (mean age, 71 years). Preoperative defect sizes ranged from 3 to 30 cm2 (mean, 18 cm2). All wounds resulted from Mohs surgery for cutaneous malignant neoplasms; 2 were adjacent to previous reconstructions. No recurrence of tumor was seen during the study period. No permanent frontal branch injuries occurred. One patient developed a moderate cellulitis. Photographic analysis showed that brow position and hairline contour were maintained in all cases.
  
  
  CONCLUSIONS
  The double-opposing rotation-advancement flap closure is a versatile reconstructive option for small, medium, and large forehead defects. The technique involves elevation of opposing, asymmetric flaps, with subsequent rotation of one side and advancement of the contralateral side. Single-stage closure may be accomplished without unappealing changes to the brow position or hairline.
authors.affiliation: Divisions of Facial Plastic and Reconstructive Surgery, Departments of Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York 11021, USA. evan.ransom@gmail.com
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Jacono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D005546:Forehead / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome; D058106:Wound Closure Techniques