Incidental Total Necrosis of a Successful Flap Due to a Secondary Operation after One Year
recurrence and the previous pretrichial incision has been completely hidden by newly grown hair. Endoscopic techniques have allowed operations to be performed with remote scars placed in less visible locations. The advantages of endoscopic techniques are hidden scars and the opportunity for complete resection allowing minimal analgesia and decreased risk of recurrence. This is a distinct advantage over piece meal excision with scar placed conspicuously over the lesion. Moreover piece meal excision has the risk of leaving residual tumour that may lead to recurrence. Distinct advantage with the technique described here is that there is no need for sophisticated equipment which increase learning time & cost. The scar in the pretrichial region is bevelled to allow preservation of hair follicles which will grow through the scar. The zig-zag pattern increases the wound length to improve exposure. The key step is the careful elevation of the subcutaneous plane under direct vision to preserve a uniform thickness of the subcutaneous tissue. This minimises the damage to the overlying skin which is associated with post inflammatory hyperpigmentation and contour irregularity. In the initial post-op period, there is some redundancy of the soft tissue on the lipoma which spontaneously contracts in 2e3 months. Hence there is no actual skin excess. The placement of the incision more anteriorly in the hairline rather than more posterior in the hair bearing scalp as used in endoscopic brow access discounts the technical difficulty of passing the instruments over the frontal bone curvature, providing a more vertical and easier access to the forehead lipoma. The technique described enables the complete removal of forehead lipomas with good aesthetic outcome without the need for demanding endoscopic techniques (Figure 2). This method can be used as an alternative technique to reduce the cost of expensive instruments as well as operative time.