PubMed · 319852
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S S Rawat. 1977. Bipedicled (vascular) forehead flap.. https://doi.org/10.1016/s0007-1226(77)90031-5
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The forehead flap is a useful technique to reconstruct deep and large nasal defects. It can safely be performed under local anesthesia in an outpatient setting. Advantages of this flap include the fact that it provides an excellent color and texture match to the missing nasal skin. Disadvantages include the fact that it is at least a two-stage procedure and that often patients require "touch up" surgeries to provide the best possible cosmetic outcome.
BACKGROUND: Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar. OBJECTIVE: The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery. METHODS: A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon. RESULTS: FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids. CONCLUSION: FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid.
BACKGROUND: The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects. OBJECTIVE: Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results. METHODS: The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed. RESULTS: Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss. CONCLUSION: With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.