Simplifying the Forehead Flap for Nasal Reconstruction: A Review of 420 Consecutive Cases

Abstract

Therapeutic, IV.

Approach to Reconstruction of Nasal Defects

“…The folded forehead flap consists of a distal extension that folds over itself to reconstruct the mucosal lining. 11,12 The folded lining provides a scaffold for implementation of a cartilage graft to reestablish structural support. Additional vertical extension of a forehead flap presents a challenge in individuals with short foreheads.…”

“…Traditionally, Doppler ultrasound is used to base the paramedian forehead flap directly over the STA to create an axial flap with a dependable vascular supply. 11 An ipsilateral flap design is preferred to limit required flap length, maintain the presence of the axial blood supply, and preserve the contralateral forehead. 11 Moreover, the width of the flap is minimized between 12 and 14 mm to limit flap congestion.…”

“…11 An ipsilateral flap design is preferred to limit required flap length, maintain the presence of the axial blood supply, and preserve the contralateral forehead. 11 Moreover, the width of the flap is minimized between 12 and 14 mm to limit flap congestion. 11 Alternate techniques to the paramedian forehead flap include the paramidline and medial forehead flap (►Fig.…”

Reconstructive Plastic Surgery in a Single Lung Transplant Recipient: A Review of Perioperative Considerations

“…The first stage occuring on 8/15/17, second stage on 9/19/17 and final stage on10/24/17.The final defect after mohs surgery was 3.2 cm x 3.1 cm with depth including cartilage and nasal mucosa ( Figure 2). Decision was made to reconstruct the lining, structure, and soft tissue defects with bilateral septal lining flaps, cartilage grafts from the septum and the right ear, and a paramedian forehead flap [12,13]. Immediately postoperatively in the recovery unit, the patient had persistent bleeding from the nose and difficulty clearing secretions.…”

“…Finally, choose a surgical technique for reconstruction that is best for the defect, immunosuppressed patient, and their goals. For example in our case, for the soft tissue coverage, we chose a paramedian forehead flap due to its robust blood supply, keeping in mind possibilities of delayed wound healing, and that it is gold standard for nasal tip defects of this size [13]. Other options of skin graft and healing by secondary intention were considered but not pursued due to the large size and depth of the defect and delayed wound healing expected in a immunosuppressed patient.…”