Frontal Flap Research Articles

Spontaneous Blinking Kinematics After Frontalis Muscle Flap Advancement.

To measure the spontaneous blinking metrics after blepharoptosis correction with frontalis muscle flap advancement. A video system was employed to measure the amplitude and velocity of spontaneous blinking of 24 eyelids after the frontalis muscle flap surgery for blepharoptosis correction. A control group with no eyelid disorders was also measured. The data of 13 eyelids who had frontalis slings with autogenous fascia, which were previously collected with the same method in another study, were used for comparison. Digital images were used to measure the superior margin reflex distance and the presence of lagophthalmos during a gentle closure of the palpebral fissure. Superficial keratitis was assessed by corneal biomicroscopy. The mean amplitude of spontaneous blinking was 6.3 mm in controls, 2.6 mm in the frontalis flap patients, and 2.1 mm in the fascia sling group. The mean blink velocity was 133.8 mm/second in controls, 39.0 mm/second (3.7 standard error) after the frontalis flap, and 36.3 mm/second in patients with frontalis sling with fascia. For these 2 parameters, there was no statistical difference between the surgical groups, but a significant reduction when compared with the control group. No significant association was found between lagophthalmos and keratitis and the surgical procedure. There is no difference between the blinking metrics of eyelids operated using the frontalis muscle flap advancement technique or frontalis sling with autogenous fascia. The presence of lagophthalmos and keratitis also does not differ between the 2 procedures.

Nasal Reconstruction with Composite Axial Paramedian Forehead Flap – Case Report

Background. Post-traumatic, acute or secondary nasal reconstruction or after tumor ablation involves various techniques that use local, loco-regional or distant flaps, transpozitioned or freely transferred. The reconstruction can be performed at the same time in the case of acute trauma of the nasal pyramid or secondary, at a later time if the local and general situation of the patient requires this. The median frontal flap, simple or composite, ensures a good quality reconstruction of all the aesthetic subunits of the nasal pyramid. The versatility of the flap and the aesthetic quality of the reconstruction result make the median frontal flap a choice solution for nasal pyramid reconstructions where local flaps are not indicated. The reconstruction can be done in two steps or in one step if the pedicle flap is subcutaneous. Case report. The article presents a case of total reconstruction of the nasal lobe after a complex dog bite trauma in which a composite median frontal flap, doubled with auricular cartilage, was used to restore the alar and columella cartilages. Conclusion. The axial paramedian forehead flap is a valuable technique in nasal reconstruction, offering favorable aesthetic outcomes when performed by skilled surgeons.

Frontal Flaps for Reconstruction of Nasal Defects

Nasal reconstruction is no longer just about filling in a nasal defect, it aims for an aesthetic and functional results. It is a three-dimensional reconstruction, restoring the mucosal plane, the osteo-cartilaginous architecture and the skin coverage to which Burget added a fourth dimension, the aesthetic result. Frontal flaps have been used for a very long time to repair nasal defects. Their popularity is mainly linked to their proximity to the recipient site, their good vascularization and especially the color and texture of the frontal skin which are significantly similar to those of the nasal skin. The frontal flap is the technique of choice in the reconstruction of full-thickness nasal tissue defects. We adopted the reconstruction by frontal flaps for the repair of multiple nasal defects, concerning multiple patients all treated at the plastic and aesthetic surgery department of the Mohammed VI University Hospital of Tangier over a period of 2 years going from March 2021 to March 2023. The goal of this study is to evaluate its contribution and answer the following question; What are the indications of using frontal flaps, its advantages and limitations in rhinopoiesis? and to draw practical recommendations regarding its use.

Advantages and Disadvantages of Reconstruction of the Nostrial Ala by Composite Graft Apropos of a Case

Introduction: The authors report a case of nasal reconstruction by frontal flap and compound graft on an amputation of the nostril. The aim of the work is to determine the advantages and disadvantages of forehead flap with compound graft in nasal reconstruction. Observation: A 30-year-old patient with no particular history was admitted to the stomatology and maxillofacial surgery department of the University Hospital of OWENDO for amputation of the left nostril by human bite. The examination revealed a loss of cutaneous-musculo-cartilo-mucous substance of the nasal ala and part of the tip of the nose. The indication for reconstruction by frontal flap associated with a compound graft was established. The 1st operation allowed a repair combining a septal mucosal graft with the auricular cartilage and the frontal flap. The 2nd stage was performed on D26 and consisted of weaning and repositioning of the frontal flap, completed by degreasing at the level of the nasal wing. Result deemed satisfactory. Discussion: The use of the frontal flap is classically done in 3 stages with defatting in the 2nd stage and can be coupled with a compound graft. This use can also be done in 2 stages with degreasing and late weaning in the 2nd stage with or without a compound graft. One of the advantages remains the good reliability, and one of the disadvantages the frontal scar. Conclusion: The combination of frontal flap and composite graft allows good reconstruction of the nasal ala.

Marcus-Gunn jaw winking syndrome: case series study and management algorithm

ABSTRACT Purpose To identify a rationale for treatment of patients with Marcus Gunn jaw winking syndrome (MGJWS). Methods Retrospective review of 38 consecutive patients with MGJWS referred to a single tertiary institution. Clinical data included visual acuity, ocular motility, side of jaw-wink, presence or absence of ptosis, levator function, clinical photographs, and management undertaken. Thirty-two patients were operated on with customized surgery by a senior surgeon (FQL). Results Cases with no ptosis or mild ptosis were managed conservatively. Levator advancement (LA) was successful in case of moderate ptosis and negligible synkynesis but resulted in a more evident synkinesis. Levator resection (LR) in patients with severe ptosis was associated with high rate of ptosis recurrence. Ptosis was adequately corrected in all patients submitted to uni- or bilateral levator excision (LE) and bilateral frontalis suspension (FS) or unilateral frontalis flap (FF). Jaw winking resolved in all patients submitted to LE but recurred in three cases at a later stage. Strabismus surgery was performed simultaneously in case of associated esotropia or hypotropia. Conclusions Moderate ptosis can be corrected with LA, but success is not related to levator function and synkinesis becomes more evident postoperatively. In severe ptosis, LR showed unpredictable results. In case of severe ptosis and severe synkinesis, uni- or bilateral LE and bilateral FS are recommended; unilateral FF is an alternative in patients who refuse bilateral treatment, as the cosmetic outcome is usually better than after unilateral FS.

Squamous cell carcinoma associated with an active cutaneous leishmaniasis in immunocompetent patient: case presentation of an unlikely association and literature—review

BackgroundAssociation between leishmaniasis and malignancy can be classified into four categories: leishmaniasis mimicking malignancy, leishmaniasis co-existing with malignancy, malignancy developing in patients with leishmaniasis scar, and leishmaniasis developing in patients with malignancy. In immunocompetent patients, the main form of association is cutaneous squamous cell carcinoma (cSCC) developing within cutaneous leishmaniasis scar years after cutaneous leishmaniasis is cured. Association of active cutaneous leishmaniasis and cSCC is exceptional, we are aware of two more cases.Case presentationA 30-year-old man presented with 2 years history of an unhealed wound on the dorsum nasi. As there still exist few sites of leishmaniasis in Morocco, systematic screening for leishmania was performed. Leishmania bodies were identified on slit skin smear by Giemsa staining. The patient received local antibiotic and on-site injections of 4 cc of meglumine antimonate for 2 months without any improvement. The lesion volume has increased significantly, a biopsy revealed an invasive squamous cell carcinoma. After staging assessment, the patient underwent a complete removal of the nasal tumor with a 1-cm margin, associated with right modified radical neck dissection. Histopathological examination confirmed the diagnosis of SCC with no lymph nodes metastasis. Nasal reconstruction was performed 2 weeks later using a frontal flap. Oncology meeting board advised adjuvant radiation on the tumor. The patient is followed up regularly and remains free of disease for a year now.ConclusionAlthough many cancers are related to infection (viral or parasitic), there is no proven link between leishmaniasis and malignancy. However, there are many etiopathogenic theories based on pathology finding that involve chronic inflammation inducing dysplasia, mitotic abnormalities, and expression of p53.

Optimizing two-stage surgery by expanding single-stage nasal reconstruction in the COVID-19 era.

The COVID‐19 pandemic led to a decrease in the number of operating rooms available. Single‐stage islanded forehead flaps have emerged as a good alternative to the classic frontal flap helping to diminish the surgical waiting list. We present our case series of 6 patients reconstructed with islanded forehead flaps between February and July 2020.The purpose of this report is to assess the advantages and disadvantages of this technique in order to inform which subgroup of patients may benefit from the one‐stage flap, now the pandemic is better controlled.

Application of e-PTFE Frontalis Suspension in the Treatment of Congenital Ptosis in Children

PurposeAnalysis of the value of expanded polytetrafluoroethylene (e-PTFE) frontalis suspension applied to children with congenital ptosis.MethodsEighty clinical cases of children with congenital ptosis from October 2019 to October 2021 were randomly selected from our hospital. All children were divided into the observation group (n = 44) treated with e-PTFE frontalis suspension and the control group (n = 36) treated with frontalis flap suspension according to the treatment procedure. Comparison of eyelid condition [palpebral fissure height, margin reflex distance (MRD), eyelid closure time], ocular surface status [corneal fluorescein staining (CFS) score, tear film breakup time (TBUT), surgical eye lacrimal river height (LRH), sehirmer test I (STI)], frontal muscle strength of affected side, cosmetic results and complications in both groups at 1, 6 and 12 months postoperative follow-up.ResultsAt 1, 6 and 12 months after surgery, there was no significant difference in terms of palpebral fissure height and MRD between both groups (p > 0.05); After surgery, the eyelid closure time was shorter in the observation group than in the control group (p < 0.05). At 1, 6 and 12 months after surgery, the CFS scores were lower in the observation group than in the control group (p < 0.05); At 6 and 12 months after surgery, the TBUT was longer and the surgical eye LRH was higher in the observation group than in the control group (p < 0.05); At 1, 6, and 12 months after surgery, there was no significant difference in STI between both groups (p < 0.05). At 1, 6 and 12 months after surgery, the frontal muscle strength of affected side was higher in the observation group than in the control group (p < 0.05). At 1, 6, and 12 months after surgery, there was no significant difference in cosmetic results between both groups (p > 0.05). The overall complication rate in the observation group (6.82%) was lower than that in the control group (25.00%) (p < 0.05).ConclusionThe surgical and cosmetic results of e-PTFE frontalis suspension and frontalis flap suspension applied to congenital ptosis are comparable, but the former has the advantage of faster postoperative recovery, better ocular surface status, less frontali muscle strength damage and fewer complications.

Pedicled frontal periosteal rescue flap via eyebrow incision for skull base reconstruction (SevEN-002)

PurposeCerebrospinal fluid (CSF) leakage is one of the major complications after endoscopic endonasal surgery. The reconstructive nasoseptal flap is widely used to repair CSF leakage. However, it could not be utilized in all cases; thus, there was a need for an alternative. We developed a pericranial rescue flap that could cover both sellar and anterior skull base defects via the endonasal approach. A modified surgical technique that did not violate the frontal sinus and cause cosmetic problems was designed using the pericranial rescue flap.MethodsWe performed 12 cadaveric dissections to investigate the applicability of the lateral pericranial rescue flap. An incision was made, extending from the middle to the lateral part of the eyebrow. The pericranium layer was dissected away from the galea layer, from the supraorbital region towards the frontoparietal region. With endoscopic assistance, the periosteal flap was raised, the flap base was the pericranium layer at the eyebrow incision. After a burr-hole was made in the supraorbital bone, the pericranial flap was inserted via the intradural or extradural pathway.ResultsThe mean size of the pericranial flap was 11.5 cm × 3.2 cm. It was large enough to cross the midline and cover the dural defects of the anterior skull base, including the sellar region.ConclusionWe demonstrated a modified endoscopic technique to repair the anterior skull base defects. This minimally invasive pericranial flap may resolve neurosurgical complications, such as CSF leakage.

Precise resection and defect repair of external nose malignant tumor

Objective: To explore the methods for the accurate resection of malignant tumors of the external nose, and the accurate evaluation and repair of tissue defects. Methods: We collected 48 cases with nasal malignant tumors treated in 980 Hospital, Joint Support Force of the People's Liberation Army from January 2010 to June 2020, including 28 males and 20 females, aged 36-86 years. The pathological types of tumors included basal cell carcinomas (n=29), squamous cell carcinomas (n=11), trichilemmal carcinomas(n=6), denoid cystic carcinoma (n=1) and non-Hodgkin lymphoma (n=1). Tumor resection was mainly based on the traditional extended resection determined by the safety margin, and Mohs surgery was used to minimize the scope of resection, for the margin that significantly affected the repairing results, such as the lesion adjacent to the nasal alar margin, nasal columella or deep easy-penetrating margin. All cases obtained tumor resection and primary/secondary defect reconstruction. Results: According to the pathological type and tumor size, the safe resection margin was mainly 4-10 mm, and Mohs surgery was used in 24 cases. Limited-size defects in 38 cases were repaired with double-leaf flaps, kite flaps, nasal dorsum brow flaps, nasolabial flaps or free tissues. Among 10 cases with compound defects, 8 cases were repaired with frontal flaps, including 4 cases with single frontal flaps, 2 cases with additional titanium mesh stent reconstruction and 2 cases with over and out frontal flaps. During follow-up of 1 to 10 years, all the flaps survived without flap necrosis, and the postoperative nasal contour and ventilation were satisfactory. One patient had tumor recurrence 18 months after operation, 2 patients died of cardiovascular and cerebrovascular diseases, and other patients survived without tumors. Conclusions: Mohs surgery can basically meet the requirements for precise resection of external nasal malignant tumors. Individualized application of adjacent tissue flaps and various frontal flaps is a reasonable choice to achieve the satisfactory outcome of external nasal repair and to take into account the complexity of operation.

A Case Report of Successful Management with Long Term Survival of Basal Cell Carcinoma of the Internal Canthus of the Right Eye

Basal cell carcinoma (BCC) is the most frequently occurring malignant periocular tumor. The aim of treatment remains surgery with negative margins. We report a case of 65-year-old woman who was diagnosed with BCC of internal canthus of the right eye, in October 2011. The patient was treated by surgical resection in 2 steps with reconstruction by a frontal flap. The treatment resulted in complete remission without any recurrence after ten years of surgery.

Reconstruction of post–burn facial deformities, using stretched flaps

Objective. Improvement of the surgical treatment results in patients with post-burn deformities of the face, using maximal restoration of cutaneous coverings of principal parts with optimal application of stretched tissues in adjacent places.&#x0D; Materials and methods. Into the investigation were included 37 patients, who were treated in 2009 - 2019 yrs,23 men and 14 women, ageing 10 - 62 yrs old (median age have constituted 25.7 yrs old). For facial defects plasty were applied the stretched frontal flap (5), lateral and lower facial flaps (4), submandibular and submandibularly-cervical (8), cervical (7) and cervical and cervico-brachial flaps (16). In 2 patients with bilateral affection the cervical and cervico-brachial flaps were applied on both sides.&#x0D; Results. All the flaps applied took the root primarily. During first postoperative 24 h in 4 patients venous congestion in cervical and cervical-brachial flaps was noted, which have disappeared after application of the antiaggregate preparations. Main criteria of estimation of the treatment far remote results were: the completeness of the cicatrices excision, the secondary deformity occurrence and restoration of the face main contours. Far emote results were studied in 17 patients and were estimated as good. In other patients the result is unknown.&#x0D; Conclusion. Depending on the cicatricial defect localization and presence of unaffected tissues in various anatomical zones of the face and neck, application of the stretched flaps is possible, what permits to obtain a sufficient quantity of viable plastic material with textural properties, which are close to defect. Using stretched flapsin various anatomical zones of face and neck good result was obtained in immediate and far remote periods of observation.

Rhinopoïese après amputation traumatique totale dans l’enfance chez un enfant de 11 ans

Fortunately, traumatic total amputations of the nose are rare, especially in children. Their reconstructions generally require several operative steps, most often associating cartilaginous grafts (rib and/or concha), a free radial antebrachial flap for mucosal reconstruction and a frontal flap for the skin covering. These are therefore long and complex procedures requiring a trained surgical team and maximum patient adherence to their treatment plan. The clinical case described is that of an 11-year-old child presenting a sub-total amputation of the nose and having undergone reconstruction with skin expansion of the frontal flap due to a horizontal frontal scar of unknown origin and a particularly low hair implantation.

Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair.

Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature. A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications. Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 ± 1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 ± 1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 ± 0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months. In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.

Facial Reconstruction after Surgical Excision of Basal Cell Carcinoma

Background and Aim of Study: The aim of this study was to evaluate the outcomes of different facial flapsused for reconstruction after surgical excision of basal cell carcinoma.Patients and Methods: Patients with BCC of the facial area were 128 cases. The cases were treated, andfollowed up between January 2012 and April 2018. Results: There was a single case of tumor recurrencein the frontal area. Also scar formation in female patient over 60 years old was noted. The case of scarformation was notes after frontal flap which used for treatment of nasal defect.Otherwise, there was no patient with any complications (like infective wound, keloid, scar formation,ischemia, or necrotic tissues), have been seen among the rest of the cases at the end of our study on 2020. Inall male cases that treated with skin graft after excision of the tumor in frontal area which was 8 patients; atthe end of follow up period, the color of skin and tissue harmony was coordinated.Conclusion: No specific flap or graft can be done for all the types of BCC, we should choose the mostappropriate flap or graft. Recurrent ratio was very low.

Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection.

Introduction:Nonmelanoma skin cancer (NMSC) is responsible for high morbidity and mortality, resulting in a high cost to the health system. The nose is the leading region affected by this type of tumor and may need reconstruction by tissue transfer. The paramedian forehead flap (PFF) is one of the main options used, and the factors that influence the result should be studied. The FACE-Q questionnaire allows the assessment of appearance, quality of life, and side effects related to the procedure, whereas the Nasal Obstruction Symptom Evaluation questionnaire enables the nose function evaluation.Methods:This study evaluates nasal reconstruction with a PFF after resection of NMSC with the FACE-Q questionnaire and Nasal Obstruction Symptom Evaluation. Spearman Rank correlation coefficient tests between the questionnaire results and patients' characteristics were performed.Results:The questionnaires were completely answered by 49 patients who underwent this reconstruction between 2011 and 2019 in a cancer center. The patients’ evaluations demonstrate high satisfaction with appearance, quality of life, side effects, and function. Completing reconstruction under 6 months was associated with a higher quality of life among patients (P = 0.002). Reconstruction of lining or scaffold, moment of flap division, complications, and number of operations did not show an association.Conclusion:This study suggests that the PFF is a reliable option for nasal reconstruction. Identifying the total reconstruction time as an impact factor on patients’ quality of life should be considered when planning treatment.

Invited Discussion: Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap (SCS-20-02336).

Invited Discussion: Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap (SCS-20-02336).

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap.

Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.

Naissance de la rhinoplastie en Occident. Part I : textes fondateurs et vrais précurseurs

The birth of rhinoplasty in the West was driven by a great demand for reconstruction of noses destroyed voluntarily or not, post-traumatic or medical. Two men emerge strongly through their work and writings: Gaspare Tagliacozzi for the brachial flap and Joseph Carpue for the frontal flap. Both of them describe a different method but based on the same skin flap principles. But were they really the first? History tells us that other, more anonymous people before them had used these same methods on a large scale but without leaving any conclusive or very significant written trace. The use of flaps or grafts, methods, which are the true pillars of plastic surgery, opened up perspectives much wider than the nose. But history has retained the name of these two men through their writings. If they were not the precursors, they were nevertheless promoters, laying the foundations of modern plastic surgery and promoting the spread of these great principles throughout the world.

Combining Rotation and V-Y Design for Lower Forehead and Temporal Region Reconstruction With Myocutaneous Frontal Flap: Our Experience on 27 Consecutive Cases.

Because of direct sun exposure, lower forehead and temporal area are anatomical regions with frequently observed skin tumors. The resulting defects after oncological ablations are usually treated, especially in older patients, by split thickness skin grafting or A-to-T and O-to-T flaps if facing small defects. On specific sites that expose bone or periosteum as well as when a skin graft is best avoided for cosmetic reasons, alternative reconstructive procedures should be considered. An excellent option is the use of myocutaneous frontal flap with rotation and V-Y design, which provide a reliable coverage of defects especially of the temporal area, dispensing appropriate like-tissue by its wide arc of rotation. Between 2010 and 2019, 27 patients underwent myocutaneous frontal flap with rotation and V-Y design reconstruction of medium-to-large-sized soft-tissue defects of the lower forehead and temporal area after tumor excision. The malignant skin lesions involved were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 9), and melanoma (n = 1). Twenty one patients were male, and 6 were female with an average age of 64 (54-86) years. All defects were successfully resurfaced with no local recurrences. The authors present a modification to myocutaneous frontal flap harvesting, with emphasis on its extensive arc of rotation with a V-Y design to minimize donor-site morbidity. The advantages of myocutaneous frontal flap with rotation and V-Y design include a good contour with excellent color, texture, and thickness match and good to excellent aesthetic results.