BACKGROUND: The midline forehead flap is used in the reconstruction of large, deep defects of the medial canthal area and lower eyelid. Drawbacks are a cosmetically unfavorable skin bulge at the nasal bridge and obliteration of the natural medial canthal concavity, requiring correction in a second stage. OBJECTIVE: We adopted a modification of the technique to avoid these drawbacks. METHODS: We reviewed the medical records and photographs of patients who received the tunneled midline forehead flap procedure in the repair of medial canthal defects and in the anterior lamellar repair of eyelid defects. The forehead flap was elevated in the subdermal plane, and the pedicle was de-epithelialized and transferred through a subgaleal tunnel from the pivot point of the flap into the primary defect. RESULTS: Nine patients had defects of the medial canthal area, medial part of the eyelids, or both after surgical removal of malignant tumors. Follow-up ranged from 5 months to 6.1 years (mean 2.1 years, median 11 months). In all cases, flap viability was maintained, globe protection was achieved, and the concave architecture of the medial canthus was preserved. CONCLUSION: The tunneled midline forehead flap can be an advantageous single-stage technique in medial canthal and medial eyelid repair.
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