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2001, British Journal of Plastic Surgery
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: 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.
Plastic and Aesthetic Research, 2016
Aim: Reconstruction of orofacial soft tissue defect is often challenging and this is more difficult in resource challenged environment. This retrospective study highlights our experience with the use of forehead flap to overcome some of the challenges of orofacial reconstruction in a resource depleted environment. Methods: A 23-year retrospective analysis of all patients who had orofacial defect reconstruction using forehead flap in our department was undertaken. Information was sourced from patient's case notes and operating theatre records. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results: A total of 43 patients were managed within the period reviewed and consisted of 31 (72.1%) males and 12 (27.9%) females. Trauma 24 (55.8%) accounted for most defect and the lip was the commonest site of defect. Complete forehead flap was used in 31 (72.1%) of cases and when timing of defect repair is considered, delayed reconstruction was the preferred method. Postoperative complications was observed in 8 (18.6%) patients and consisted of failed flap in 2 (25.0%) patients, tumor recurrence in reconstructed site in 2 (25.0%) patients and tumor occurrence in forehead flap donor site in 1 (12.5%) patient. Conclusion: The forehead flap remains a reliable option in orofacial soft tissue defect reconstruction. It is easy to raise and can provide coverage for wide defects as far as the paramandibular and submandibular regions. Moreover, it does not require patient repositioning.
Dermatologic Surgery, 2006
The forehead flap is a commonly used technique to reconstruct the deep and large nasal defects. It can be conveniently performed under local or general anesthesia and provides a very good color and texture matching to the nasal skin, which makes it a suitable graft harvesting site for nasal reconstruction. It has only single disadvantage disadvantagethat it is a two-stage procedure and “finishing” surgeries are needed occasionally for best surgical and cosmetic outcome. In this paper, we describe three different applications of forehead flaps
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...
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 2018
1.The ideal free flap for scalp reconstruction has adequate thickness, surface area, and vascular pedicle length 2.The simplest possible method of reconstruction should be considered in all patients while achieving adequate resection and a good functional outcome. 3.The radial forearm free flap provides excellent texture, color, pedicle length, and reliability. It provides for outstanding coverage of the forehead, temple, vertex, and occiput reconstruction. 4.In our experience, it is as hardy as the latissimus dorsi flap in withstanding postoperative adjuvant radiation, and confers multiple advantages over the latissimus dorsi free flap including faster healing times and shorter hospital stays. This article is protected by copyright. All rights reserved.
Plastic and Reconstructive Surgery, 2007
Background: Central forehead defects are difficult for the plastic surgeon. Constraints include tissue match, hair-bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominent location. Tissue expansion requires multiple operations and weeks of expansion. Local flaps result in added scars to the cosmetically sensitive forehead region. However, the forehead also provides consistent patterns of rhytides that can be used to camouflage local flap scars. This article describes a local flap for reconstructing central forehead skin defects that achieves tissue coverage with a cosmetically appealing result. Methods: Six patients with central forehead cutaneous malignancies were reviewed; their defects were too large to close primarily. The defects were closed using bilateral periglabellar local advancement flaps with Burow's triangles, with scars in the natural skin creases of the aging forehead. The superior triangles were oriented horizontally, which placed incisions within the frontalis muscle forehead creases. The inferior triangles were oriented obliquely within skin creases of the corrugator muscles. Central vertical incisions remained and blended inconspicuously into the aging forehead. Results: Five patients with central forehead melanomas and one patient with Mohs' defects after excision of basal cell carcinoma were referred by their dermatologists (age range, 60 to 83 years; mean, 72 years). Defects ranged from 2.1 to 5.3 cm in greatest diameter (mean, 3.7 cm). All were closed with the periglabellar flap. One minor complication of hematoma was treated with aspiration in the office. All six patients were satisfied with the results of their reconstruction. Conclusion: For central forehead skin defects up to 5 cm in diameter, the periglabellar flap offers a reconstructive option that uses local tissue and hides scars within natural forehead wrinkles, providing an aesthetically pleasing result.
Indian Journal of Surgical Oncology, 2010
The head and neck region is important both functionally and aesthetically and its reconstruction poses a formidable challenge for plastic surgeons. A perforator flap is a flap of skin or subcutaneous tissue supplied by a vessel that perforates the deep fascia to gain access to flap. With improvement in our knowledge of the anatomy of blood supply to the skin, the perforator flaps have opened a whole new horizon for the plastic surgeon to choose flaps with better function and cosmesis. The locally available perforators enable flaps to be designed with excellent match in tissue characteristics. Perforator flaps limit donor site morbidity and as they are islanded complete insetting is possible in a single stage. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supraclavicular artery flap used in the head and neck reconstruction are discussed. The more commonly used flaps are the free radial artery forearm flap and the anterolateral thigh flap while the novel ones are the thoracodorsal artery perforator flap, medial sural artery perforator flap and the toe-web flap for commissure reconstruction. The indications, reach and drawbacks of these flaps have been discussed in this review.
Plastic and Aesthetic Research, 2022
Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium. The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome. The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder, with special emphasis on local flap consideration, design, and execution.
Head & Neck, 2009
Background. The purpose of this study was to analyze the causes of flap compromise and failure in head and neck free flap reconstruction.
Eplasty, 2017
JPRAS Open, 2017
Large and deep defects in foreheads are best repaired with flaps. In these types of cases, reconstructions are made through the transfer of distant flaps, due to the small amount of available local tissue. The supraclavicular island flap (SCIF) has been extensive used for head and neck reconstructions during the last two decades. However, the flap extension is limited to the reconstruction of the superior third of the face, which may increase the risk of distal flap necrosis. The authors describe two cases of forehead reconstruction with the SCIF using a microsurgical technique.
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
Jurnal Rekonstruksi dan Estetik
Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised wit...
Plastic and Reconstructive Surgery, 2003
The platysma myocutaneous flap, because of its thinness and pliability, meets preeminently the requirements for reconstruction of defects in the oral cavity. The authors describe their experience in 85 patients with regard to the use of the platysma myocutaneous flap and its complications. The various regions reconstructed were primarily the tongue (47 percent), the buccal mucosa (27 percent), and the floor of the mouth; the remaining flaps were used for the lower alveolus, the lower lip, and the face. None of these patients had received preoperative irradiation, and in none of the patients under study was the flap raised when neck dissection was indicated. The maximum dimensions of the elevated flap were 6 ϫ 10 cm, and rotation of the pedicle was between 90 and 180 degrees depending on the location of the surgical defect. Partial necrosis of the flap was noticed in 17 cases (20 percent), complete flap necrosis was seen in six cases (7 percent), and wound infection was seen in three cases. The authors found the platysma myocutaneous flap to be a useful alternative for lining limited intraoral defects after tumor resection.
Dermatologic Surgery, 2017
Iranian Red Crescent medical journal, 2012
Reconstruction of nasal skin after tumor resection is imperative for full patient rehabilitation; and use of similar skin is necessary to achieve best esthetic and functional results. This clinical series study represent management of patients with large nasal defects (up to 4x7 cm) using subcutaneous pedicle island paramedian forehead flap, during a period of 2007-2009, 8 patients with large nasal defects were repaired with this flap, among them 5 patients were male and 3 patients were female with mean age of 53 years, all cases were reconstructed with island pedicle flap in a single stage. Good and satisfying results were achieved in all cases except for one case that was operated again for debulking of flap. Island paramedian forehead flap provides esthetic and functional results in a single stage reconstruction of defects with various sizes and locations. This variation of forehead flap is a good choice especially for those patients that have problems with cost or problem with m...
The hemifrontal flap is an efficient way of reconstructing large unilateral defects that involve the hemiforehead.
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