The Forehead Flap: The Gold Standard of Nasal Soft Tissue Reconstruction

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.

Supraclavicular osteocutaneous free flap: Clinical application and surgical details for the reconstruction of composite defects of the nose

“…Forehead flap still remains the gold standard in nasal reconstruction and its advantages are well known . Its main drawbacks consist of the resulting unfavorable forehead scar and the need for a second donor site in case of cartilage and/or bone defects .…”

“…Forehead flap still remains the gold standard in nasal reconstruction and its advantages are well known. [3][4][5] Its main drawbacks consist of the resulting unfavorable forehead scar and the need for a second donor site in case of cartilage and/or bone defects. 9,10 Bone resorption of nonvascularized grafts may also lead to secondary deformities and collapse, especially when postoperative irradiation is necessary.…”

“…1,2 Despite the recent advances in microsurgery and the evolution of perforator flaps, the forehead flap, the oldest surgical technique in nasal reconstruction, remains the gold standard. 3 The forehead flap with the application of the esthetic subunit principle can be performed in two or three stages providing excellent results for coverage of soft tissue nasal defects. 4 Extensive composite defects, however, require concomitant restoration of the osseous and/or cartilaginous nasal skeleton.…”

More than just the helix: A series of free flaps from the ear

“…Only one surgical correction involving removal of excess dorsal nasal (flap) skin was required ( Figure 6F). (with numerous modifications) and postauricular flaps (Bakhach et al, 1999;Correa et al, 2013;Orticochea, 1971;Tollefson & Kriet, 2005;Yoon et al, 2006). Free flaps, such as the radial forearm flap, are disadvantaged by often requiring multiple operations, as they do not provide all three anatomical layers, and often struggle to reproduce the precise anatomical aesthetics of the nasal region.…”

“…Only local flaps can usually meet this demand but are disadvantaged by their visible donor site scarring and moreover, may not be available. Nasal reconstruction in particular, provides a challenge, and since the earliest report of the use of the forehead flap in ancient India, a variety of modifications and other local and pedicled flaps have been described (Bakhach, Conde, Demiri, & Baudet, 1999;Correa, Weathers, Wolfswinkel, & Thornton, 2013;Orticochea, 1971;Tollefson & Kriet, 2005;Yoon, Benito-Ruiz, García-Díez, & Serra-Renom, 2006). However, the latter usually require multiple stages and often result in suboptimal aesthetics due to the failure in recreating the subtleties of nasal anatomy.…”