A systematic aesthetic approach to primary closure of the donor site following transposition of vertical forehead flaps.

Twenty patients underwent transposition of a vertical forehead flap to correct defects of the middle third of the face. The treatment and results are reported and evaluated. Based of the width of the secondary forehead defect, the best technique of direct closure was determined. Simpler cases were resolved by careful application of the basic techniques of plastic surgery--undermining and scalp flap rotation. When a forehead defect larger than 4.5 cm was expected, previous forehead skin expansion seemed advisable. A primary, tension-free suture of the forehead defect was achieved in every case, thus significantly improving the aesthetic outcome of the operation.