HAIRLINE RECONSTRUCTION UTILIZING MODIFIED WINGED V-PLASTIC HAIR-BEARING FLAPS AND FOCAL ANASTOMOTIC LINE EXCISIONS

BACKGROUND. A large, recurrent basal cell carcinoma involving the left forehead and suprajacent hair-bearing scalp was excised, following wh ich an esthetically acceptable reconstruction of the scalp and hairlin e margin was accomplished. OBJECTIVE. A method of utilizing two hair-b earing flaps to cover a large defect at the hair-bearing scalp margin will be photographically demonstrated, and the maneuvers to precisely reconstruct the scalp's anastomotic margin with the forehead will be s hown and discussed. METHODS. Dual hair-bearing ''winged'' V-plastic fl aps were evolved anteriorly, the two flaps joined, an M-plasty (Webste r) was then incorporated to spare hair-bearing scalp posteriorly, and the entire conjoined scalp flap then advanced anteriorly to the forehe ad. The precise curvatures of the anastomotic line were reestablished by exact excisions of forehead skin underlying the hair-bearing scalp flaps, or amputations of overlying hair-bearing scalp in excess of for ehead needs. RESULTS. All esthetically pleasing and reasonably exact r econstruction of the hair-bearing scalp and forehead anastomotic line was accomplished. CONCLUSION. A precise reconstruction of the forehead /scalp margin can be accomplished utilizing a combination of technique s, including hair-bearing ''winged'' V-plastic flaps; an M-plasty, and the serial removal of segments of both glabrous and nonglabrous skin to reestablish the frontal hairline margin. (C) 1996 by the American S ociety for Dermatologic Surgery, Inc.