title: Comparison of W-Plasty vs Traditional Straight-Line Techniques for Primary Paramedian Forehead Flap Donor Site Closure.
abstract: OBJECTIVE
  The paramedian forehead flap (PMFF) donor site scar is hard to disguise and may be a source of patient dissatisfaction.
  
  
  OBJECTIVE
  To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) closure techniques of the PMFF donor site.
  
  
  METHODS
  A retrospective cohort study was conducted at the University of California, San Francisco Medical Center. Clinical history and operative reports were reviewed for 31 patients who underwent a PMFF procedure performed between November 1, 2011, and May 29, 2014. Blinded photographic analysis of postoperative photographs was performed.
  
  
  METHODS
  The pedicled component of the PMFF was raised primarily with either a W-plasty or traditional SL design.
  
  
  METHODS
  Standard photographs of the donor site, obtained at least 90 days after surgery, were reviewed and scored in a blinded fashion by 4 dermatologic surgeons using a 100-point visual analog scale (from 0 [worst possible outcome] to 100 [best possible outcome]) and a 5-point Likert scale (from very poor to excellent). Interrater reliability was assessed via Cronbach α testing.
  
  
  RESULTS
  All 31 forehead flaps survived during this study period; 16 PMFFs were raised with the W-plasty technique and 15 were raised with the SL technique. The W-plasty and SL groups were similar in terms of age, sex, and race/ethnicity (mean [SD] age, 68.4 [12.4] vs 61.8 [11.6] years; 13 [84%] vs 9 [60%] men; and 15 [94%] vs 13 [87%] white). Patients undergoing W-plasty closure had significantly higher mean visual analog scale scores compared with those undergoing SL closure (72.8 [18.3] vs 65.6 [18.1]; P = .03). Mean Likert scale scores for W-plasty were higher than those for SL closure, but the difference was not significant (3.77 [1.02] vs 3.43 [0.98]; P = .08). Overall interrater reliability for the visual analog scale and Likert scale scores were 0.67 and 0.58, respectively.
  
  
  CONCLUSIONS
  Patients undergoing PMFF donor site closure using a primary W-plasty technique demonstrated better mean scar appearance of the forehead donor site compared with SL closure. The primary W-plasty technique did not result in any PMFF losses and should be considered for appropriate patients.
  
  
  METHODS
  3.
authors.affiliation: Medical student, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco.
authors.forename: Emmanuel J
authors.initials: EJ
authors.lastname: Jáuregui
authors.affiliation: Medical student, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco.
authors.forename: Neelima
authors.initials: N
authors.lastname: Tummala
authors.affiliation: Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center.
authors.forename: Rahul
authors.initials: R
authors.lastname: Seth
authors.affiliation: Department of Dermatology, School of Medicine, University of California, San Francisco.
authors.forename: Sarah
authors.initials: S
authors.lastname: Arron
authors.affiliation: Department of Dermatology, School of Medicine, University of California, San Francisco.
authors.forename: Isaac
authors.initials: I
authors.lastname: Neuhaus
authors.affiliation: Department of Dermatology, School of Medicine, University of California, San Francisco.
authors.forename: Siegrid
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Dermatology, School of Medicine, University of California, San Francisco.
authors.forename: Roy
authors.initials: R
authors.lastname: Grekin
authors.affiliation: Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Knott
mesh_terms: D000368:Aged; D004954:Esthetics; D005260:Female; D005546:Forehead / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome; D058106:Wound Closure Techniques