Forehead Flap Periorbital Reconstruction

Abstract

To evaluate functional and aesthetic results of periorbital defect repair using forehead flaps.Design: Retrospective review of patients who received periorbital defect repair by 3 of us with a paramedian forehead flap alone or in conjunction with other local or regional flaps, bone grafts, or cartilage grafts. Flap survival, functional results, and postoperative complications were determined by physical examination at regular followup. Three experienced surgeons other than us quantified aesthetic outcomes using a 10-cm visual analog scale.Results: Eighteen patients underwent periorbital defect repair between August 1, 1989, and December 31, 2000. Defects ranged from 8 to 300 cm 2 (mean, 46.8 cm 2 ) in area. The most commonly involved primary struc-tures were the medial canthus, lacrimal drainage system, and medial upper eyelid. The mean improvement on a 10-cm visual analog scale was 1.6 from before resection to after reconstruction and 3.8 from tumor resection to after reconstruction. In all relevant cases, globe coverage and lacrimal drainage system patency were excellent. No patients experienced fistula formation or eyelid retraction. Conclusion:The reliability, versatility, and relative technical simplicity of the forehead flap provide excellent cosmetic and functional results in reconstruction of intermediate-sized periorbital defects, especially those associated with nasal defects.

The Tunneled Forehead Flap in Medial Canthal and Eyelid Reconstruction

“…The latter method helps to maintain the normal medial canthal concavity 13 . The forehead flap is a useful technique to reconstruct large, deep defects of the medial canthal area extending into the eyelid, 3 although four of our patients had superficial canthal or eyelid defects only, of whom two had received previous flap surgery. Other local flaps could have been used in the other two patients.…”

“…W hen a large, deep defect of the medial canthal area or medial part of the lower eyelid requires reconstruction, a forehead flap is a useful option. [1][2][3] The median forehead flap is supplied by both supratrochlear arteries and occasionally the supraorbital artery. This flap has a wide pedicle, implying a limited reach, impaired venous drainage, and distorted eyebrows.…”

An algorythmic approach to restoration of the fronto-naso-periorbital skin defects using the forehead flaps

“…Since forehead flaps have constant arterial anatomy with a rich vascular network, wide arc of rotation, appropriate thickness, and provide good harmony with surrounding skin (Konz, 1975), they can be used isolated or in conjunction with other local and regional flaps for repair of simple to three dimensional Quatela et al (1995) and Park (2000) used the forehead flap for defects larger than 1.5e2 cm. Price et al (2004) stated that forehead flaps are an excellent choice for reconstruction of intermediate-sized periorbital defects, especially associated with nasal defects. The indications for this flap were expanded, and utilised as an axial-pattern flap for moderate sized defects of the forehead in four cases.…”

Mohs Micrographic Surgery of the Eyelid: An Overview of Anatomy, Pathophysiology, and Reconstruction Options

“…The paramedian forehead flap is an example of a two‐stage axial interpolation flap. It has been used to repair surgical defects of the medial canthus, upper and lower eyelids, and lacrimal system . The supratrochlear artery is the main vascular support for this flap .…”

“…The base of the forehead flap pedicle should measure approximately 1 to 1.5 cm in diameter . The narrow pedicle width helps the flap to rotate inferiorly . Care must be taken to avoid damaging the underlying vasculature when dissecting and elevating the pedicle .…”