Paramedian forehead flap reconstruction for skin tumors involving central subunit of face: An analysis of 37 cases

Abstract

Tumors of facial skin are common in upper part of central subunit of face. Defects after resection require a flap, which is pliable, thin, and has a good colour match. Among the various local flaps available paramedian forehead flap is a good option. Patients and methods: Patients reconstructed with paramedian forehead flap during the period from January 2015 to March 2020 were included in the study. Data regarding the demographic, clinical characteristics, and treatment details was recorded, and analyzed for postoperative complications and cosmetic outcomes. Results: Paramedian forehead flap reconstruction was performed in 37 patients who were resected for tumor involving upper central subunit of face. Median age of patients was 57 years. Male to female ratio was 1.4:1. All tumors were resected with a negative margin. Nodal disease was managed by superficial parotidectomy only (4/ 37), superficial parotidectomy along with supra-omohyoid neck dissection (6/37) and modified neck dissection (1/37). In five patients additional buccal mucosa graft was used to reconstruct conjunctiva. Additional flaps were required in two patients in whom nasolabial and mustarde flaps were used. Partial flap loss occurred in one patient. There was no major flap loss. Surgical site infection developed in only one patient, who had partial flap loss. On subjective assessment, nearly 60% patients described their appearance as good. Conclusion: Facial reconstruction in area of dorsum of nose and medial aspect of both eyelids using paramedian forehead flaps is a simple and quick procedure.

Danger Zone for Paramedian Forehead Flap Elevation: Maximizing Flap Length and Viability

“…Although flap dissection initially leaves an apparent forehead defect, resolution occurs through successive tissue remodeling and leaves overall cosmetic outcomes that are viewed positively by both the patient and surgeon [19]. Paramedian forehead flaps provide several other advantages, including providing ample tissue to cover large defects, and can be used to correct congenital [20] or acquired lesions [9,21,22]. Additionally, the paramedian forehead flap can be reused to repair remnant defects [23,24], as well as having the inherent flexibility to be modified by reconstructive surgeons to best suit individualized, patient-specific midfacial features [8,22,25].…”

“…As with any procedure, the paramedian forehead flap poses a variety of post-surgical risks. Minor complications include infection, partial nasal collapse, incomplete nasal obstruction, epidermolysis, and alar asymmetry [6,21,[26][27][28]. Major complications include flap necrosis (both full and partial), nasal obstruction, alar notching, and asymmetry.…”

The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations

“…PMFF reconstruction allows adequate restoration or maintenance of vision, eyelid function, and cosmesis. The proximity of the flap matches skin colour, tissue texture and structure between the local donor and recipient site [ 1 , 18 , 19 ]. Additionally, the pliable PMFF can be thinned and trimmed to conform to the defect’s complex contours (Fig.…”

The Utility of the Paramedian Forehead Flap in Lower Eyelid Reconstruction

“…12,13 The use of forehead flaps has been described for reconstruction of the medial and upper eyelid, but there is a paucity of literature concerning its use in reconstruction of the lower eyelid. 14,15 In this case series, we present 2 patients who underwent reconstruction of lower eyelid defects using a PMFF, providing evidence of its wider use for reconstructive purposes. Given that the PMFF provides adequate tissue bulk, skin color match, and vascular abundance to the eyelid, it should be considered as part of the reconstructive ladder when addressing lower lid defects.…”

“…However, it is less frequently used in eyelid reconstruction 12,13 . The use of forehead flaps has been described for reconstruction of the medial and upper eyelid, but there is a paucity of literature concerning its use in reconstruction of the lower eyelid 14,15 . In this case series, we present 2 patients who underwent reconstruction of lower eyelid defects using a PMFF, providing evidence of its wider use for reconstructive purposes.…”