Refinements of the island median forehead flap for reconstruction of the medial canthal area.

Extensive excision of malignant tumors in the medial portion of the eyelids involving the medial canthal tendon and orbicularis oculi muscle results in the lateral displacement of the eyelids and forward drift of the medial canthal region during the healing process if they are not repaired. We present three successful cases of reconstruction of an extensive defect in the medial portion of the eyelids by the island median forehead flap with frontal muscle and frontal galea aponeurotica to repair the medial canthal tendon and orbicularis oculi muscle. This improved technique successfully avoids lateral displacement of the eyelids and forward drift of the medial canthal region, and is a treatment choice for the extensive medial canthal defect.