Subcutaneous forehead island flap for nasal reconstruction

Bangabandhu Sheikh Mujib Medical University Journal, 2016

Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2016

Non-melanoma skin cancers are the most frequent skin tumours; in 25.5% of cases, they are reported to affect the nasal area. For an excellent surgical outcome, first of all the radical excision of the lesion is important, with appropriate margins of healthy skin in order to avoid recurrences. Moreover is important to achieve a good aesthetical result, avoiding distortion of the aesthetic units and preserving their functions. We have applied the modified crescentic flap, described by Smadja in 2007, to 24 nasal skin defects left by oncologic surgery. It consists of the crescent-shaped resection of Burow's triangle all around the alar groove that allows the advancement of the flap to the tip of the nose, hiding the scar in the alar groove. The outcome and the long-term follow-up were completely satisfactory both for patients and for surgeons. For skin defects localized in the midline or paramedian line of the dorsum of the nose, the crescentic flap seems to be a good solution to o...

Journal of Craniofacial Surgery, 2014

Reconstruction of nasal defects is challenging because it requires covering skin, supporting framework, and lining. Traditionally, the forehead flaps are transferred in 2 stages; however, it can be accomplished in a single stage or in 3 stages. Few published studies are available about the paramedian forehead flap using the intermediate stage (3-stage) and the aesthetic subunits principle. The purpose of this study is to evaluate the use of the paramedian forehead flap in 2 and 3 stages for nasal reconstructions, highlighting the indications, complications, and technical details and evaluating the patient's satisfaction through a questionnaire about the quality of life (Derriford Appearance Scale 24). A retrospective review was performed between 2011 and 2013 for a consecutive series of 11 patients who underwent nasal reconstructions using the paramedian forehead flap in 2 or 3 stages. All preoperative and postoperative data were collected, and outcomes were also assessed through a questionnaire about the patients' postoperative quality of life. The causes of nasal lesions varied among skin cancer, trauma, and infection. Twostage paramedian forehead flap reconstruction was performed upon 4 patients, whereas the 3-stage reconstruction was performed for 7 patients. Of the 10 survey respondents, 6 were highly satisfied (score of 11-27), and 4 were moderately satisfied (score of 28-44), whereas no one was dissatisfied after his/her surgical nasal reconstruction procedure. Whether the approach is accomplished in 2 or 3 stages, all areas of the reconstructed nose must be firmly supported. Applying the nasal subunits principle seems to contribute to an overall satisfied population in our study, according to the score obtained by the questionnaire about quality of life.

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

Nigerian Journal of Medicine, 2024

It is common practice to reconstruct small nasal defects following the nasal subunits principle but for near-total nasal defects, the best method of reconstruction based on esthetic considerations is still debatable. For large defects that involve both sides of the nose symmetrically, near-total resurfacing results in satisfactory cosmetic outcome. We present a case of a middle-aged man who had nasal resurfacing of the nose with a paramedian forehead flap following the excision of a broad benign cutaneous lesion on a background of long-lasting generalised skin disease.

2020

Introduction: Nasal reconstruction is a difficult problem because it entails reconstruction of skin, cartilage, osseous frame work and lining mucous membrane [1]. The result must be satisfactory both cosmetically and functionally [2]. The anatomical reconstruction depends on the principle of subunit divisions of the nose. Which states: If the reconstruction is less than the defective subunit the result will appear patchy. On the other hand, if the reconstruction exceeds the limits of the subunit the nose will appear unnatural [3,4]. Local and regional flaps are used in nasal reconstruction each type has its own advantages, disadvantages and donor site morbidity [5-9]. The aim of this work is to demonstrate the advantages and disadvantages of expanded forehead flap in nasal reconstruction. Material and Methods: A retrospective review of 25 consecutive cases of total or nasal dorsum reconstruction who were operated upon in a single clinic by 3 separate surgeons adopting the same princ...

Just as rhinoplasty represents the most complex aesthetic operation, nasal reconstruction represents the most complex facial reconstruction. The nose is a complex three-dimensional structure and along with the eyes, represents a major aesthetic focus of the face. Although discussion of nasal reconstruction often focuses on the visible, aesthetic result, the functional outcome is also paramount to a successful operation. Nasal reconstruction can be conceptualized into three main components: lining, support, and coverage. Of the three, lining failure is most likely to lead to a total reconstruc-tive failure. There are several options for reconstructing the nasal lining, including mucosal flaps, skin grafting, local flaps, prefabricated forehead flap, three-stage forehead flap, forehead flap turnover, and free tissue transfer. In most cases requiring lining, there is only a focal full-thickness defect that is amenable to repair with a thinned folded forehead flap. If the area of lining is not local to the primary defect or extends beyond it, then one of the above-mentioned options may be needed. The structural support of the nose is paramount for airway patency as well as aesthetic durability. Except in cases of total nasal reconstruction, as mentioned above, most cases requiring support represent a focal defect with need for replacement of a segment of cartilage. Conchal cartilage represents an optimal choice given its location, size, and shape. The natural curvature and thickness of conchal cartilage makes it an ideal choice for structural support, especially when nonanatomic grafts are needed, such as alar rim grafts (►Fig. 1). The donor site is also favorable in that no significant aesthetic deformity results and complications are rare. The approach to nasal coverage can be further categorized by the nasal subunits and subunit principle of reconstruction. Simply stated, there are nine nasal subunits based upon transitions in shadow between natural convex-ities and concavities where scars are most inconspicuous (►Fig. 2). Furthermore, if a significant portion of any given subunit is missing (e.g., > 50%) then completing excision and reconstructing the entire subunit will often lead to superior cosmetic results. Within these fundamental concepts are a multitude of unique defects with unique requirements , which necessitate the judgment of an experienced surgeon to lead to the optimal result. As is typical in plastic surgery, there are no hard and fast rules that apply for 100% of cases. Abstract The forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction. As the gold standard for nasal soft tissue reconstruction, the forehead flap provides a reconstructive surgeon with a robust pedicle and large amount of tissue to reconstruct almost any defect. Modifications provided by masters like Burget and Menick have only increased the utility of this exceptional flap. Maintaining an axial pattern, utilizing the pedicle ipsilateral to the defect, extending the flap at right angles with caution when extra length is needed, using a narrow pedicle, and early subperiosteal dissection are the guiding principles for forehead flap reconstruction of the nose. In addition, lining defects can be addressed simply and reliably with a folded forehead flap.

Mædica, 2014

Nasal reconstruction has be one of the most challenging procedures in reconstructive plastic surgery. Small nasal defects may be closed by primary suture or covered by small local flaps or skin graft. But in large nasal defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. We chose a case report of one patient admitted in our clinic in 2012, who represented a daring task for us. Best suited for paramedian forehead flap reconstruction, the patient underwent a procedure in 2 steps, which led to a very satisfying nose both for the patient and for the surgeon. In order to achieve a good coverage with the smallest donor site defect, we used a flap based only on the left supratrocheal artery, which gave us the possibility to rotate the flap without distorting the vessels. In such cases, the best option, aesthetically and functionally, for the patient still remains the paramedian flap, modified from the original ...

Otolaryngology - Head and Neck Surgery, 2005

To report a new technique using a bivalved, full-thickness paramedian forehead flap. The unique vascular anatomy of the supratrochlear artery allows the skin and subcutaneous tissue to be separated from the frontalis muscle and pericranium. The deep layers serve as a pliable, vascularized intranasal lining. Bone and cartilage grafts can be placed as "sandwich" grafts between the deep and superficial layers of the flap. A retrospective review of 5 cases. All flaps survived. Four minor complications occurred in 3 patients. These resolved with minimal treatment. The full-thickness forehead flap is a viable option for large defects or for the difficult situation in which intranasal local flaps are not an option. The gold standard for replacement of the intranasal lining is a septal mucosal or vestibular local flap. The full-thickness forehead flap is an option in patients for whom other lining flaps are not available. C-3.

International Journal of Dermatology, 2009

Background Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects. Methods During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months. Results In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor. Conclusions The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.

Open Access Macedonian Journal of Medical Sciences

Background Reconstruction of nasal defects represents a significant challenge in reconstructive surgery, due to nose’s delicate anatomy, combined with its functional and aesthetic relevance. Radical tumor excision, function preservation and a pleasing aesthetic outcome are the primary targets. The reconstructive approach will depend on the aesthetic subunit involved, size and depth of the defect. We describe our experience in the reconstruction of nasal skin defects of the tip, columella, alae, with a 2-stage nasolabial flap. Patients and Methods After institutional review board approval, a retrospective study was performed including consecutive patients (n=489) who underwent surgery for skin cancer of the nose, from 2016 to 2020 at the Service of Burns and Plastic Surgery, “Mother Theresa” University Hospital Center, of Tirana. Results The procedures were well tolerated and achieved good cosmetic results without complications. Conclusions The nasolabial 2-stage based flap is a well...

Aesthetic Plastic Surgery, 2012

Background Reconstruction of face deformities resulting from skin cancer includes reconstructing the area with similar tissue. This prospective study aimed to compare the functional and aesthetic outcomes between two types of local flaps (the island pedicle flap vs the bilobed flap) used in reconstruction of the ala and back nose. Methods In this study, 120 patients with skin cancer of the nose underwent ala and back reconstruction: 60 patients using the island flap (IF group) and 60 patients using the bilobed flap (BF group). The two groups were homogeneous for sex, age, and anatomic area. Complications, scarring according to the scale of Vancouver, cosmetic appearance, and disorders of sensations were analyzed, and statistical analysis was performed using Chi-square and analysis of variance (ANOVA). Results Early complications were more common in the BF group than in the IF group (p \ 0.005). The Vancouver Scar Scale scores were significantly better for the IF patients (p \ 0,005), who also showed better results in the analysis of cosmetic outcomes (p \ 0.005).

Surgical & Cosmetic Dermatology

Introduction: The use of a median-frontal flap for nasal reconstruction was first described in 600 B.C., and it is still widely used for the reconstruction of nasal tumoral lesions. Objective: To report the experience of a medical school's plastic surgery service in the use of this flap type. Methods: A retrospective descriptive study was carried out with a series of 35 cases surgically treated from January 2005 to June 2015. Results: The patients' mean age was 68.6 (± 10.8) years, with a predominance of the male gender (68.6%). The median-frontal flap was used for reconstruction after resection of tumors, with basal cell carcinoma being the most frequent. Conclusions: The median-frontal flap is the ideal reconstructive choice for many patients, with good aesthetic and functional outcomes.

Vojnosanitetski pregled, 2011

Background. Posttraumatic and postoperative defects of columella and the tip of the nose are difficult to reconstruct. There are several operative methods described in the literature, and many of them are step-by-step procedures with long duration. The aim of this study was to present one-step procedure for reconstruction of the columella and the tip of the nose with island-shaped arterial forehead flap. Case report. A 45-year old man was submitted to surgical excision of basocellular skin cancer. After the excision, a defect of the columella and tip of the nose the remained, 3 ? 2.5 cm in dimensions, with exposed alar cartilages. During the same operation, the defect was covered with an island-shaped arterial forehead flap. Postoperative one-year course was uneventful, without signs of tumor recurrence after one year, and further surgical corrections were unnecessary. Conclusion. Considering the results of our operative technique, we believe that middle island-shaped forehead flap ...

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.