Glabellar flap

Abstract

Defects of the medial canthus and nose can occur due to trauma, congenital anomalies, or as a result of tumor resection. Reconstruction of this area is challenging due to a lack of adjacent mobile tissue and lack of tissue similar in color, texture, and thickness (Facial Plastic Surgery Clinics 19: 113-122, 2011; Ophthalmologica 220: 368-371, 2006; Eye 86: 597-605, 2000). Whenever possible, local flaps are preferred over free skin grafts. The glabellar flap can be used by itself or in combination with other procedures to reconstruct the medial canthus. Other options for medial canthal reconstruction include a bilobed flap, rhomboid flap, and full-thickness skin graft (Eye 86: 597-605, 2000; Colour atlas of ophthalmic plastic surgery, Boston, 2008). The glabellar flap is most appropriate for medial canthal defects that do not extend far into the eyelid, cheek, or nose region (Eye 86: 597-605, 2000). Patients with a continuous brow are poor candidates for this procedure as well. Furthermore, this procedure is generally not used in young patients as moderate skin laxity is required for this procedure (Colour atlas of ophthalmic plastic surgery, Boston, 2008). When assessing a patient with a medial canthal defect, the lacrimal drainage apparatus must be examined. Reconstruction of the lacrimal drainage apparatus will not be addressed here. In the glabellar flap operation, an inverted V is created in the glabellar region and the glabellar tissue is rotated into the medial canthal region (Colour atlas of ophthalmic plastic surgery, Boston, 2008). The size of the glabellar flap is determined by the size of the defect, with the inferior border of the flap created from the superior border of the defect (to correct the vertical height), the lateral boarder created from the most lateral border of the defect (to correct the horizontal width), and the superior border equal in length and 45° away from the lateral border (Eye 86: 597-605, 2000).