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

Abstract

Purpose The paramedian forehead flap (PMFF) is a reconstructive option for large eyelid defects and orbital exenterations. We report a series of cases where PMFF reconstruction was carried out at various institutions in Australia. Methods This study was a multi-centre, retrospective, non-comparative case series investigating the clinical outcomes of the PMFF for reconstructing periocular defects and orbital exenterations. Results This case series describes twenty-seven patients (Female = 15, Male = 12), operated between 1991 to 2019, with a median age of 81 years (range: 45–93 years). Defect locations involved combinations of the medial canthus (16/27, 59.3%), upper eyelids (7/27, 25.9%), lower eyelid (4/27, 14.8%), both upper and lower eyelids (5/27, 18.5%), and orbital (7/27, 25.9%). There were no cases of flap necrosis. Minor post-operative complications were observed in ten patients with the most common being lagophthalmos. Median duration of follow-up was 17months (Range: 2months- 23years). Conclusions The PMFF is a versatile reconstructive tool for a range of periocular defects and orbital exenterations with minor post-operative complications.

Customized Reconstruction of Lower Eyelid Defects

“…Lower eyelid repair aims to preserve functional elements, including maintaining an intact tear-corneal rim and eye closure, avoiding blocking the visual field, reducing scarring, and, if possible, meeting aesthetic requirements by hiding scars. Direct closure, 24 skin grafting, 25 the Tenzel semicircular flap, 11 the McGregor flap, 26 the Hughes tarsoconjunctival flap, 12 the Mustarde cheek rotational flap, 27 the Fricke’s flap, 28 the forehead flap, 29 and the tripier flap, 30 which are frequently used, do not meet these criteria. Another drawback is that significant expertise is required to select the right approach based on the size and location of the defect in all procedures.…”

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

“…Some studies found no statistically significant correlation between diabetes and flap success ( 13 ). There are studies proving that successful flap division could occur within 1–2 weeks despite any underlying comorbidities ( 15 ). In our study, the absence of flap necrosis in any of the patients indicates that with strong and sufficient vascular support, it can be successfully used even in full-thickness defects.…”

Functional and Symmetry Outcomes After Forehead Flap Reconstruction of Medial Peri‐Ocular Defects

“…[9][10][11] While there have been few studies in the literature describing reconstruction with PMFF and surgical outcomes, there have been no studies describing symmetry outcomes of PMFF reconstruction of the periocular region. 12,13 In the current study, we aim to describe reconstruction of the medial periocular region with the paramedian forehead flap (PMFF). The medial canthus is not only anatomically important for the lacrimal drainage system but also presents at a fixed distance from the facial midline, which is important for cosmetic outcomes.…”

“…The paramedian forehead flap has traditionally primarily been used in the reconstruction of nasal defects and has not been extensively studied in reconstruction of periorbital defects 9–11 . While there have been few studies in the literature describing reconstruction with PMFF and surgical outcomes, there have been no studies describing symmetry outcomes of PMFF reconstruction of the periocular region 12,13 …”