Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. 8 A Novel Approach for the Reconstruction of Medial Canthal and Nasal Dorsal Defects: Frontal Hairline Island Flap Semra KarzNda?, MD, Bu ¨ lent Sacak, MD, Serdar Bayraktaroglu, MD, Arzu O ¨ zcan, MD, Kemal Ugurlu, MD, Lu ¨ tfu ¨ Bas, MD Istanbul, Turkey Medial canthal and dorsal nasal defects after sur- gery have been a challenging problem for surgeons and patients. The main purpose in reconstruction is not solely covering the defects with similar skin and soft tissue, but also causing minimal donor- area morbidity. The authors described an ellipti- cal fashioned frontal island flap at the level of the frontal hairline, nourished by the vascular net- work composed of supraorbital and supratrochlear arteries, then carried subcutaneously to the defect area at medial canthus and upper nose. Any extra incisions above the eyebrow to control the pedi- cles were not necessary. Donor region was closed primarily; thus, scarring was hidden at the hair- line. We present our frontal hairline island flap design and results in our series of 10 patients. In our study, we aimed to reduce scarring at do- nor area by planning a forehead island flap in an elliptical fashion at the frontal hairline. There are no more incisions than the elliptical incision over the hairline. Primary closure of skin flaps at the donor ensures a final scar that is hidden at the frontal hairline border. Forehead hairline island flap is an important flap for small- and medium-size defects as an alternative to conventional parame- dian forehead flap. Key Words: Frontal hairline island flap, medial canthus, supraorbital, supratrochlear arteries U pper nasal and medial canthal regions are not only having importance on the aes- thetic appearance of the face, but also skin cancers are commonly seen in these re- gions because of chronic sun exposure. 1 Multiple local flaps are described for reconstruction of soft tissue defects after oncological surgery for these areas. The main purposes of reconstruction are to provide the best aesthetic results in the means of color and tex- ture accordance while causing minimal donor-area morbidity possible. Frontal flaps have been used in reconstruction of upper nasal and medial canthal areas. 1,2 Advantages of the frontal flaps such as large soft tissue coverage, acceptable color, and texture ac- cordance makes the frontal flap first choice in re- construction. On the other hand; frontal scarring, deformity in brow line, and necessity of a second procedure are the major disadvantages of these flaps. Different variations of frontal flaps such as sub- cutaneously transposed or turnover fashioned frontal flaps are described to overcome these disad- vantages. 2,3 These variations may put away the ne- cessity for a second procedure but may not hinder the vertical obvious scarring over the frontal region. Formerly, the successful use of frontal scalp island flaps has been reported in eyebrow reconstruction. 4 Both supraorbital and supratrochlear neurovascular networks nourish these flaps. Frontal bulkiness is seen as a consequence of the torsion of subcutaneous ped- icle. Another research done in the light of former data describes the supraorbital island flap used in small- and medium-size defects in the periorbital region. 4 In this technique, 2 separate (1.5Y2 cm) incisions are done at the medial and lateral borders of pedicle to control the pivot point and the pedicle itself. In our study, we planned an elliptical fashioned frontal island flap at the level of the frontal hairline, nourished by the vas- cular network composed of supraorbital and supra- trochlear arteries, then carried subcutaneously to the defect area at medial canthus and upper nose. Any extra incisions above the eyebrow to control the 1653 From the Plastic, Reconstructive and Esthetic Surgery Depart- ment, Sisli Etfal Education and Research Hospital, Istanbul, Turkey. Address correspondence and reprint requests to Semra KarzNda?, MD, Plastic, Reconstructive, and Esthetic Surgery Department, Sisli Etfal Education and Research Hospital, Istanbul, Turkey; E-mail: semrakarsidag@yahoo.com