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. 2013 May;27(2):96-103.
doi: 10.1055/s-0033-1351231.

The forehead flap: the gold standard of nasal soft tissue reconstruction

Bryan J Correa  1 , William M Weathers  1 , Erik M Wolfswinkel  1 , James F Thornton  2
Affiliations

The forehead flap: the gold standard of nasal soft tissue reconstruction

Bryan J Correa et al. Semin Plast Surg. 2013 May.

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.

Keywords: Mohs surgery; forehead flap; nasal lining; nasal reconstruction.

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Figures

Fig. 1
Fig. 1
Nasal subunits.
Fig. 2
Fig. 2
The conchal cartilage graft approximates the natural curvature of the ala.
Fig. 3
Fig. 3
(A) Courses of the supratrochlear and supraorbital arteries. (B) Periosteal blood supply of the forehead flap. The arteries become more superficial as they travel away from the brow.
Fig. 4
Fig. 4
Folded forehead flap for repair of alar and nasal lining defects. (A) A cut is made at the distal portion of the flap at the alar rim. (B) The cut allows easy rotation and inset. (C) Final flap inset.
Fig. 5
Fig. 5
(A) Ispilateral forehead flap with narrow pedicle. (B) Pivot point can be at or below the brow, always rotate medially, and graft the jelly side of flap to aid in hemostasis and wound care. (C) 7-months postop.
Fig. 6
Fig. 6
The flap is elevated from thin to thick with early transition to subperiosteal.
Fig. 7
Fig. 7
Donor site allowed to heal by secondary intention.
Fig. 8
Fig. 8
Aggressive thinning of the flap at division and inset.
Fig. 9
Fig. 9
(A) Ala and tip defect. (B) 2-weeks post initial operation. (C) 1-year postop.
Fig. 10
Fig. 10
(A) Large tip and partial dorsum defect. (B) 2-weeks post initial operation. (C) 5-months postop.
Fig. 11
Fig. 11
(A) Flap appearance after initial operation. (B) 7-months postop.
See this image and copyright information in PMC

References

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