Use of Modified Islanded Paramedian Forehead Flap for Complex Periocular Facial Reconstruction

Abstract

The paramedian forehead flap is a workhorse flap for reconstructing the nose and periorbital regions. Many variants are described including an islanded flap. However, eyebrow reconstruction is not usually performed with these flaps. The authors describe a patient suffering from postburn scarring medial to the left eye, including loss of the left eyebrow. He underwent a single-stage transfer of the paramedian forehead flap. The flap incorporated scalp hair, which restored the missing eyebrow hair after transfer. The donor defect closed primarily. The paramedian forehead flap is amenable to customization by including a segment of hair-bearing scalp to concomitantly reconstruct the nasal dorsum and eyebrow.

Single-stage eyebrow reconstruction with a double opposing forehead flap: a case report

“…Tripathy and colleagues described a similar single-stage operation using an islanded forehead flap to reconstruct a glabella and medial eyebrow electrical burn defect. 3 In our case, the residual oncological defect was likely to require postoperative radiotherapy and would need robust, vascularised tissue that would be able to withstand the rigours of radiotherapy. The decision to reconstruct this defect with a regional flap in favour of free tissue transfer upholds the reconstructive principle of replacing 'like with like'.…”

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

“…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]. Most importantly, these flaps, when dissected and implemented correctly, are associated with positive long-term outcomes [9].…”

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

“…The successful repair of the medial orbital wall via de-epithelisation of the distal half of the flap was demonstrated in our cases. A single flap can be constructed to cover multiple periorbital defects/subunits (e.g., medial canthus, medial eyebrow, and nasal radix) [ 6 , 20 ]. Additionally, splitting the PMFF can help simultaneously recreate upper and lower eyelids and this was demonstrated successfully within our cases [ 21 ].…”