A Cohort Study of Paramedian Forehead Flap in 2 Stages (87 Flaps) and 3 Stages (100 Flaps)

Stahl, Adelana Santos; Gubisch, Wolfgang; Fischer, Helmut; Haack, Sebastian; Meisner, Christoph; Stahl, Stéphane

doi:10.1097/sap.0000000000000209

Cited by 24 publications

(21 citation statements)

References 12 publications

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“…If the defects are not closed, contractures or large scar formations may occur due to secondary healing or use of skin grafts [ 14 ]. Santos Stahl et al [ 15 ] and Little et al [ 16 ] reported an approximately 5% increase in the rate of skin necrosis after a forehead flap. Skin necrosis was however not noted in any of our patients.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of large facial defects using a combination of forehead flap and other procedures

Kim

et al. 2022

Arch Craniofac Surg

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Background: Reconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated.Methods: A total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients’ medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires.Results: Along with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high.Conclusion: Reconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of large facial defects using a combination of forehead flap and other procedures

Kim

et al. 2022

Arch Craniofac Surg

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“…Paramedian forehead flaps can be performed in two or three stages according to the surgeon experience and patient’s condition ( 9 , 10 ). In our study, the operations were done in two or three sessions.…”

Section: Discussionmentioning

confidence: 99%

Paramedian Forehead Flap in Large Nasal Skin Defects: Twenty-years’ Experience

Apaydın¹,

Kaya²,

Uslu³

et al. 2022

TAO

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Objective: Skin cancers occur most commonly in the head and neck region where the nose is the most commonly affected unit. The nose is the part of the face that is most exposed to trauma, sunlight, and other environmental factors. From the aesthetic and functional point of view, reconstruction of the defects occurring after skin cancer removal creates a great challenge for the surgeon. In this retrospective study, we present the success rates achieved in the past 20 years with paramedian forehead flaps used for repairing large defects of the nose. Methods: The study included 62 patients who underwent paramedian forehead flap due to nasal skin tumor [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] in Ege University Faculty of Medicine Otolaryngology Department between 2000 and 2020. Data on follow-up time, patients’ age and gender, defect sizes, and tumor types were obtained retrospectively from patient files, histopathologic examination results and patient photographs. Additional diseases such as diabetes, hypertension, and coronary artery disease that could affect flap success, were noted. Results: Out of 62 patients 29 (46.8%) were female and 33 (53.2%) were male. Their mean age was 61.4 (range: 46–88) years. Mean follow-up period was 125.6 (8–244) months. Of the 62 patients 33 (53.2%) were operated on for BCC and 29 (46.8%) for SCC. Four patients (6.5%) had recurrences during their follow-up. There was no loss of the paramedian forehead flap. Conclusion: Paramedian forehead flap is a reliable option in the reconstruction of larger defects of the nose even in smokers and elderly patients who have comorbid diseases.

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“…The paramedian forehead flap is one of the most widely used flaps for full thickness reconstruction of nasal defects and is considered the gold standard for nasal reconstruction. 1 , 2 Although this technique is known for its viability in patients of all ages, having few contraindications, producing reliable and aesthetically pleasing results, 3 as well as achieving high rates of patient satisfaction and having low complication rates, 4 , 5 the paramedian forehead flap procedure has one major drawback, namely that it is a two‐stage surgery design. Traditionally, the paramedian forehead flap is transferred in two stages: stage 1 involves raising the flap and reconstructing the nasal tissues according to the nasal subunit principles, while leaving a pedicle to the donor site.…”

Section: Introductionmentioning

confidence: 99%

The role of near‐infrared fluorescence imaging with indocyanine green dye in pedicle division with the paramedian forehead flap

Schlosshauer¹,

Rothenberger

Heiß

et al. 2021

International Wound Journal

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The paramedian forehead flap is considered the gold standard for nasal reconstruction following oncologic surgery. During the 21-day delay in two-stage surgery protocols, many patients report considerably reduced quality of life because of the pedicle. This prospective case series study examined the usefulness of near-infrared (NIR) fluorescence with indocyanine green (ICG) for flap perfusion assessment and identified variables associated with time to flap perfusion. Ten patients (mean age 75.3 ± 11.6 years) with diagnosis of basal cell carcinoma (n = 9) or squamous cell carcinoma (n = 1) underwent intravenous indocyanine injection and NIR fluorescence imaging for assessment of flap vascularisation 2 to 3 weeks after stage 1 surgery. NIR fluorescence imaging showed 90% to 100% perfusion areas in all patients after 14 to 21 days. Early pedicle division occurred in two patients on postoperative days 14 and 16. One minor complication (wound healing disorder) was seen following flap takedown after 14 days. There were no associations between time to flap perfusion and defect size or flap area. NIR fluorescence imaging with ICG dye is a useful method for non-invasive perfusion assessment when used in conjunction with clinical assessment criteria. However, a decision for early pedicle division may raise risk of complications in specific patient groups and must therefore be made with great care.

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A Cohort Study of Paramedian Forehead Flap in 2 Stages (87 Flaps) and 3 Stages (100 Flaps)

Cited by 24 publications

References 12 publications

Reconstruction of large facial defects using a combination of forehead flap and other procedures

Reconstruction of large facial defects using a combination of forehead flap and other procedures

Paramedian Forehead Flap in Large Nasal Skin Defects: Twenty-years’ Experience

The role of near‐infrared fluorescence imaging with indocyanine green dye in pedicle division with the paramedian forehead flap

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