Clinical StudiesMicrosurgical Forehead ReconstructionEhrl, Denis MD; Niclas Broer, P. MD, PhD; Heidekrueger, Paul I. MD; Ninkovic, Milomir MD, PhD Author Information Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. Address correspondence and reprint requests to Denis Ehrl, MD, Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Engelschalkingerstr. 77, Munich 81925, Germany; E-mail: [email protected] Received 27 July, 2016 Accepted 16 September, 2016 DE and PNB equally contributed to this manuscript. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors report no conflicts of interest. Journal of Craniofacial Surgery 28(1):p 212-217, January 2017. | DOI: 10.1097/SCS.0000000000003275 Buy Metrics Abstract Reconstruction of the forehead remains challenging. Especially in cases of large or even complete forehead defects, local flaps and skin grafting may not be an option, necessitating free flap coverage. The aim of this retrospective case series was to develop an algorithmic surgical approach as well as to evaluate surgical and aesthetic outcomes of microvascular-based forehead reconstructions, using gracilis muscle or anterolateral thigh flaps in 15 cases. The mean size of the defects was 84.6 (range: 25–160, ±44.1) cm2, all with significant area of bone exposure. The free flap reconstructions included 7 gracilis muscle flaps, covered with 1.2-mm-thick unmeshed split-thickness skin grafts, and 8 anterolateral thigh flaps with a mean size of the free flaps of 160 (range: 56–300, ±78.6) cm2. In all patients, wound healing at the donor site was uneventful. Minor complications occurred in 3 patients and required small revision procedures. This case series demonstrates that microsurgical reconstruction of multiple entities of forehead defects poses a reliable method, especially in large and complex defects. In our opinion, given low risks for major complications and superior aesthetic results, the gracilis muscle flap covered with unmeshed split-thickness skin graft is ideally suited to reconstruct the forehead and should be one of first choices. © 2017 by Mutaz B. Habal, MD.