FIG. 21-16. The plan was to remove the skin grafts, re-establish the frontal hairline with total scalp rotation flaps, and resurface the forehead with a serratus neurovascular transplant.

FIG. 21-17. Scalp flaps are elevated.

FIG. 21-18. The left frontal hairline has been re-established. The serratus MVT has resurfaced the left forehead. The long vascular pedicle will be tunneled under the cheek to the anterior facial vessels.

FIG. 21-19. A split-thickness skin graft from the posterior scalp is used to cover the transplanted muscle, to maximize the color match. A skin graft was needed to close the defect created by the scalp advancement.

FIG. 21-20. Improved color match and hairline are sees at 5 years postoperatively, with no recurrence to date.

CASE 4

A young woman had undergone resection and radiation of a nasopharyngeal carcinoma 7 years before referral for reconstruction.

FIG. 21-21. Three previous attempts have failed to close the nasoethymoid defect. (From Clapson, J.B., Whitney, T.M., Buncke, H.J.: The small free flap. In Symposium on Microsurgical Reconstruction for Trauma. Edited by F-C. Wei, Hampton Press, Norfolk, in press, 1990.)

FIG. 21-22. The superficial temporal artery and vein have been isolated as the recipient vessel.

FIG. 21-23. The left forehead was folded down through a half coronal incision. The cavity was completely debrided of all mucosal lining and the exposed bone debrided.

FIG. 21-24. The vascular pedicle of the serratus MVT was passed across the forehead under the flap to the left superficial temporal vessels for repair. The external muscle was skin grafted, as well as the surface exposed to the nasal cavity.

FIG. 21-25. Eight-year follow-up shows a closed wound without drainage and restoration of contour. No mucocele has developed.

CASE 5

A 61-year-old woman suffered a left zygomatic/orbital fracture in a car accident. Original reconstruction required a silastic implant that became infected.

FIG. 21-26. There was a bony defect over the left orbital rim.

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