The Forehead Flap

Plastic and Reconstructive Surgery, 2009

Background: Nasal reconstruction with use of the forehead flap has been performed for hundreds of years. Forehead vasculature has been studied; however, anatomical relationships to the forehead flap have not been adequately examined. This anatomical study evaluated the vascular anatomy of the paramedian forehead flap. Methods: Five fresh cadaver heads were used. Four underwent cannulation of internal and external carotids bilaterally followed by injection of a barium sulfate/gelatin mixture and three-dimensional computed tomographic angiography to evaluate vascular anatomy. In one specimen, the supraorbital, supratrochlear, and angular arteries were cannulated. Methylene blue dye was injected to identify vascular territory followed by injection of contrast media for dynamic four-dimensional computed tomographic angiography. A paramedian forehead flap was raised and the injections were repeated. Colored-latex was injected followed by dissection. Measurements were made on a computed tomography workstation. Results: A periorbital plexus extends to 7 mm over the orbital rim. The angular, supratrochlear, and supraorbital arteries communicated into the flap by means of the vascular plexus. The supratrochlear vessel ran axially into the forehead flap and continued across the transverse limb of the flap. The deep branch of the supratrochlear ascended the periosteum under the flap. Noncontiguous vessels were noted to back-fill with latex through the subdermal plexus in the distal flap. Conclusions: Maximal three-vessel flow may be obtained by preserving periosteum at least 3 cm over the orbital rim and beginning the flap 7 mm above the orbital rim. The subdermal plexus of the forehead is robust, enabling preservation of the distal transverse limb of the forehead flap.

British Journal of Plastic Surgery, 2001

We have found that double opposing rectangular advancement flaps in the forehead may be easily performed under either local or general anaesthesia, and are associated with high patient satisfaction and low morbidity. We claim no originality for the mode of reconstruction, but highlight its broad spectrum of application and its popularity with junior plastic surgeons passing through our unit. We have found that the term 'H-flap' provides a readily communicated alternative to 'double opposing rectangular advancement flaps'.

Background: The lateral forehead flap (LFF) less and less used in current practice is a very reliable flap, using the entire frontal aesthetic unit focused on the superficial temporal pedicle. We present our surgical technique, and three clinical examples that illustrate the different indications in our service; we will discuss advantages and disadvantages. Methods: Three cases of squamous cell carcinoma of cheek and nose were resected and reconstructed using the lateral forehead flap, the secondary defect was split-skin grafted. Results: All faps survived and functional outcomes are attained in all patients, with acceptable aesthetic results. Conclusions: The LFF is a robust tool in the arsenal of the reconstructive surgeon. The flap can cover several facial and intraoral defects, which would otherwise require distant flaps or free flaps. It should mastered by all facial reconstructive surgeons.

Otolaryngology - Head and Neck Surgery, 1995

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 t0 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 contrac-Lure 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.) rain I¥1any surgeons consider forehead skin the best match of color and texture in reconstructing nasal defects. Unfortunately, because of the thickness of forehead skin, composite grafts cannot survive reliably solely on imbibition. Thus surgeons traditionally transpose the tissue from the forehead onto the nose by a two-stage procedure: the first stage transfers the tissue on a vascular pedicle, and the second stage divides the pedicle after inosculation and

2021

Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respe...

Eplasty, 2017

Background: Managing post-traumatic or post-oncosurgical facial defects presents challenges. Minor defects may be treated with skin grafts or small local flaps, while larger ones necessitate advanced techniques like tissue expanders, prefabricated flaps, or free flaps. The enduring utilization of the forehead flap over centuries underscores its reliability in reconstructing substantial and intricate facial defects. Aim: Assess the viability and adaptability of forehead flap for facial reconstruction. Materials and Methods: 20 patients who underwent coverage of facial defects after trauma or tumor excision using forehead flaps were retrospectively analysed. The patient satisfaction and flap-related complications were analyzed. Results: 20 patients (18 males and two females) underwent reconstruction of different facial defects using 20 forehead flaps. The complication occurred in one patient only. The remaining 19 patients showed no complications and passed an uneventful follow-up period. All the patients were fully satisfied. Conclusion: The forehead flap effectively addresses facial defects, likely offering optimal results with its excellent skin match in color, texture, and thickness. Despite the rising popularity of free flaps, the forehead flap remains a valid and secure choice, ensuring both aesthetic and functional success in covering facial defects.

Aesthetic Plastic Surgery, 2002

The eyebrow is an important subunit of facial aesthetics and expression. Partial or total absence of the eyebrow is an unacceptable and disturbing condition. Aesthetic eyebrow reconstruction is a challenging problem for the reconstructive surgeon. In this paper a simple and reliable procedure for eyebrow reconstruction is presented. An aesthetically satisfactory result was obtained and a perfect match with the undamaged eyebrow was achieved. In selected cases this technique may be a strong alternative to the procedures that had been defined earlier.

British Journal of Plastic Surgery, 2004

Journal of Oral and Maxillofacial Surgery, 2007

Purpose: Complex defects resulting from surgical excision of facial cancer sometimes require reconstruction using microvascular free tissue transfer. Tissue transfer from areas distant from the face can resolve many problems, but often provides a poor cosmetic match with facial skin. The submental flap helps surmount this problem. Cervical skin has similarities with face skin, and because this is a regional flap, it helps eliminate microsurgical risks. In this article we present a series of 9 cases, review the anatomy and the surgical technique, and explain the advantages and limitations of the submental flap. Patients and Methods: A successive series of 9 patients in which this reconstruction was performed was reviewed retrospectively, and the results were analyzed. Results: Submental flap facial reconstruction was performed on 9 patients (8 men and 1 woman) between 1993 and 2004. Mean patient age was 53.6 years (range, 43 to 81 years). Eight of the 9 external skin coverage cases were associated with excision of cutaneous malignancies; 1 case involved treatment of burn sequelae. There were no cases of marginal mandibular nerve palsy. In 6 cases, venous drainage was disrupted after raising the flap, but without causing flap loss. This disruption was overcome in 4 to 5 days without the need for flap revision or any other interventions. Partial loss of the distal extent of the flap occurred in 2 cases. In all cases, moderately good skin color and texture match was achieved. Debulking of the flap was needed in 6 cases. The donor site recovered well with no hypertrophic scarring and no restriction to neck movement. Conclusions: The submental artery island flap is a useful reconstructive procedure that offers options to the reconstructive surgeon and has definite advantages over distant flaps in terms of ease of dissection and donor site appearance.