Reconstruction of the eyebrow.

Burn injury and excision of skin cancer can lead to the loss of an eyebrow. (1) Reconstruction of the eyebrow area can present unique challenges because it is a naturally hair-beating area where the hairs' texture and the direction of follicle growth are unique.

The author performed a two-stage pedicled-flap reconstruction of a male eyebrow. Over a period of several years, the patient had undergone multiple excisions of skin cancers of the right forehead. Reconstruction had been performed with split-thickness skin grafts. However, following multiple procedures, the eyebrow had been completely removed (figure 1).

[FIGURE 1 OMITTED]

The eyebrow was reconstructed during a two-stage procedure with an axial cutaneous pedicled flap obtained from the scalp. In the first stage, the superficial temporal artery was identified anterior to the tragus, and its course was traced superiorly with a Doppler probe. The flap was harvested from the temporoparietal region of the head and based on a posterior branch of the superficial temporal artery. The donor site was chosen because its hair pattern best approximated that of the lost eyebrow. The scalp flap was planned to ensure that the length of the pedicle was sufficient to reach the destination site. The pattern of the normal contralateral eyebrow was used to recreate the new eyebrow at the distal end of the flap. The scalp flap was elevated in the subgaleal layer near the top of the head. More proximally, it was dissected superficial to the temporal fascia. The skin graft covering the brow was partially excised, and the distal end of the flap was inset (figure 2). The donor site was closed primarily. Three weeks later, stage two was performed. The pedicled scalp flap was divided, and the lateral portion of the new eyebrow was trimmed and inset. The long-term outcome was satisfactory (figure 3).

[FIGURES 2-3 OMITTED]

Of the variety of reconstructive techniques available for eyebrow reconstruction--including micrograft hair transplantation--the pedicled-flap technique described herein can provide a very reasonable result. (2)

References

(1.) Converse JM, McCarthy JG, Dobrkovsky M, Larson DL. Facial burns. In: Converse JM, ed. Reconstructive Plastic Surgery. Philadelphia: W.B. Saunders, 1977:1595-1642.

(2.) Barrera A. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp. Plast Reconstr Surg 2003;112:883-90.

Sheldon R. Brown, MD, DDS 

From the Section of Otolaryngology, Department of Surgery, Carl T. Hayden VA Medical Center, Phoenix.