Comparative Analysis of Low and High Rotation Arc Single-Stage Tunnelled Forehead Flap for Medial Canthal Reconstruction

Abstract

Objective: The study aimed to promote a simpler and more efficient surgical approach for reconstructing critical areas like the medial canthal region, addressing full-thickness defects. The use of the low rotation arc single-stage forehead flap was showcased, and its outcomes were compared with other flap techniques, including the high arc single-staged forehead flap.

Methods: Twenty patients with cutaneous tumors underwent single-stage tunnelled forehead flap reconstruction following excision. Ten patients received low rotation arc (≤100°) single-stage tunnelled forehead flap reconstruction, while the remaining 10 received high rotation arc (>100°) single-stage tunnelled forehead flap reconstruction. Demographic characteristics, defect dimensions, postoperative complications, and hospital visit frequencies were retrospectively assessed. Surgical methods were described for the low rotation arc single-stage tunneled flap, and outcomes were statistically compared.

Results: Ten patients underwent high rotation arc reconstruction (mean age: 69.1 years, defect size: 4.54 cm²). Complications included desepithelialization (4 patients), partial flap necrosis (2 patients), and total flap necrosis (1 patient), with an average hospital visit frequency of 5.0. Patients with low rotation arc had significantly fewer hospital visits (P < .005).

Conclusion: Utilizing a single-stage forehead flap with low rotation arc in medial region reconstruction results in superior outcomes with fewer complications compared to high rotation arc flaps. This optimized method provides successful single-stage repair in this area.

Cite this article as: Çınar F, Sulhan A, Karakol P. Comparative analysis of low and high rotation arc single-stage tunnelled forehead flap for medial canthal reconstruction. Cerrahpaşa Med J 2026, 50, 0034, doi: 10.5152/cjm.2026.25034.