H-Plasty Reconstruction of a Traumatic Frontal Avulsion: A Case Report

Abstract

Traumatic forehead avulsion with calvarial exposure poses a reconstructive challenge in young children because the frontal skin is relatively inelastic and repair must preserve vascularity, facial symmetry, and future growth. We report a three-year-old girl who sustained a motorcycle-related craniofacial injury producing an approximately 8 × 4 cm left frontal soft-tissue defect, partial periosteal loss, exposed frontal bone, necrotic wound edges, gross contamination, and a unicortical frontal-bone fracture. Initial irrigation, debridement, traumatic-flap remodeling, and primary closure were followed by epidermolysis and skin necrosis with recurrent bone exposure. A second-stage reconstruction was therefore performed using bilateral opposing advancement flaps configured as an H-plasty. The flaps incorporated the galea and were elevated in a supraperiosteal plane to preserve the remaining periosteum and regional vascular supply. Layered closure was completed with 6-0 absorbable polydioxanone skin sutures. At postoperative days 6 and 10, the flap remained viable and provided complete coverage with a satisfactory early aesthetic and functional result. This case illustrates that H-plasty can provide vascularized, like-with-like coverage for selected traumatic pediatric forehead defects when careful debridement, broad-based flap design, tension redistribution, and preservation of the supratrochlear and supraorbital vascular territories are prioritized.