Occasionally defects of the cheek, caused by accidents, or as a result of operation for malignant disease, or from gangrene, are so extensive that plastic correction is exceedingly difficult. The margins of the defect are frequently fixed to the bone and do not permit much stretching. If the flaps are taken from the arm, the character and texture of the skin is so different from the skin of the face that the contrast is very noticeable. Then, too, it is frequently necessary to have an epithelial lining on the inside of the mouth, and though a mucous membrane lining is preferable to one of skin, it is often impossible to secure mucous membrane.
Flaps from the forehead are used to remedy these defects, and are taken with the pedicle either from the temporal region or from the middle of the forehead. This, of course, necessitates cutting the pedicle later and