Forehead Flap For Nasal Reconstruction Research Articles

The single-stage forehead flap in nasal reconstruction: an alternative with advantages.

To review the single-stage forehead flap for patient selection, technique, and main outcome measures. Patients undergoing nasal reconstruction between January 1, 1995, and June 30, 2000, were reviewed from medical records, photographs, and personal communication. All work was performed in an academic medical center. Fifty-one patients had a forehead flap for nasal reconstruction, of which 10 (20%) were repaired in a single stage. All patients had no evidence of small vessel disease, eg, hypertension, diabetes mellitus, or tobacco use. Nasal defects were limited to the upper two thirds of the nose. The technique is modified from the original description by creating a unilateral, subcutaneous pedicle, wide undermining, and partial resection of the procerus muscle. One patient had superficial epidermolysis at the distal tip of the flap. The remaining 9 patients maintained complete viability with satisfactory outcomes. One debulking procedure was performed to the glabellar area for aesthetic reasons. The average interval for returning to work was 6.6 days compared with the minimal 3 weeks for conventional interpolated flaps. In select cases, a single-stage, island midline forehead flap can be used safely as an advantageous alternative to the conventional interpolated forehead flap.

Triple-Flap Technique for Reconstruction of Large Nasal Defects

Triple-Flap Technique for Reconstruction of Large Nasal Defects

The forehead flap for nasal reconstruction.

Reconstruction of extensive nasal defects often represents a significant challenge owing to several unique qualities of the nose, such as complex topography, mobile free margins, and multiple nasal subunits. Furthermore, loss of internal nasal lining and/or structural skeletal support may be present following removal of extensive skin cancers. To describe our experience with the use of forehead flap reconstruction for extensive nasal defects. Retrospective case series. Academic health care hospital system. One hundred forty-seven patients with extensive nasal defects repaired with a forehead flap. The functional and aesthetic results were assessed. The characteristics of defects repaired with the forehead flap and the need for lining and/or cartilage were examined. The forehead flap was used to repair 147 nasal defects after Mohs excision of nonmelanoma skin cancer. Full-thickness skin was lost in all cases, structural skeletal support in 68 cases (46%), and internal mucosal lining in 45 cases (31%). Our experience and surgical technique using the forehead flap are described. The forehead flap represents one of the best methods for repair of extensive nasal defects. Near-normal functional and cosmetic results can be achieved.

The making of a specialty

The making of a specialty

Improvements in forehead flap design for nasal reconstruction.

Joseph Carpue introduced us to the use of the forehead flap for nasal reconstruction in 1814 after he read an account of its use in India. The forehead flap was the first pedicled flap to be described in European literature and it set off an immediate search for similar flaps elsewhere on the body. In fact, this initial use of the forehead flap was so inspirational that it has been given credit for the rise of plastic surgery as a specialty. The forehead flap is well situated to replace missing nasal skin due to its excellent vascularity, close proximity, and similar histologic qualities. In fact, it is safe to say the forehead flap is the first choice for reconstruction of nasal defects larger than 2.0 cm in diameter. Over the last 180 years there has been considerable refinement in the under stage and standardization of forehead flap design. This short monograph is intended to provide refinements in forehead flap design which, in these authors' opinion, provide superior nasal reconstruction results while minimizing donor site morbidity. Some of these modifications are fairly subtle while others fundamentally affect the design of a forehead flap. Incorporating these modifications will advance the sophistication of the reconstructive surgeon and improve results.

Forehead flap in nasal reconstruction

We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and 10 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contracture that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction. (OTOLARYNGOL HEAD NECK SURG 1995;113:740-7.)

Forehead flap in nasal reconstruction.

We establish criteria for anesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and 10 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contracture that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction.

Esthetic Refinements in Forehead Flap Nasal Reconstruction

To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results. Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994. University hospital ambulatory surgery department. Thirty-two patients with various nasal defects. Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim. Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients. Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. The predictability of the techniques in providing excellent results in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.

Delayed pedicle separation in forehead flap nasal reconstruction.

Nasal reconstructions with midline forehead flaps are often plagued by inadequate tip projection and excessively thick alar rims. These problems can be overcome by a combination of preliminary tissue expansion, which gains extra length, and delayed pedicle separation, which allows aggressive thinning of alar rims and shaping of the tip while its blood supply is still fully intact. Only when tip-shaping is completed is the pedicle divided and the reconstruction completed. In our experience this combination of increased flap length and improved tip shape has led to better tip projection and superior overall results. Three representative cases that demonstrate these principles are presented.

Forehead flap nasal reconstruction with tissue expansion and delayed pedicle separation.

Forehead flap nasal reconstruction with tissue expansion and delayed pedicle separation.

Skin grafted forehead flap for total nasal reconstruction in severe postburn facial deformity

Total or subtotal nasal loss is one of the sequelae of severe facial burns and requires total nasal reconstruction. Distant flaps or tube pedicles were used but the result was not good in terms of skin color match and texture. Since 1982 the authors have used a skin grafted forehead flap for nasal reconstruction and have achieved a better color match for the new nose. This forehead flap is quite rigid and a bone graft is not needed for support. However, the flap is not as easily brought down to the nasal area as the standard forehead flap; thus, in the last five cases the supraorbital and the supratrochlear arteries on both sides had to be sacrificed. There was no compromise of the blood supply to the flap and the mechanism by which the flap retains its good blood supply remains to be elucidated.

A New Forehead Flap for Nasal Reconstruction

A New Forehead Flap for Nasal Reconstruction