Aesthetic considerations in forehead reconstruction in. Preserve function and restore appearance by understanding the whys and the hows of the best surgical repairs for facial reconstruction. Its main indications are large and deep wounds located on the distal third of the nose tip and ala. In all cases in which direct closure is not possible, the local, pedicled, and free flaps discussed above provide a good option for coverage. Tailored to the respective needs, the ld flap can be used as a myocutaneous flap, a muscle flap with splitthickness skin graft, a functioning muscle flap, or a flowthrough flap. The forehead flap is relatively simple in concept and technique. Postoperative complications of paramedian forehead flap. Even if no doppler signal is found, a flap with a pedicle based along the midline of the forehead will probably survive. Previous forehead or orbital trauma or surgery with likely interruption of the blood supply of the flap tissues is a contraindication. Scotts waiver on the scalplifting force of an allout adult yank of a fistful of juvenile hair should be satisfied by your. Dec 19, 2019 forehead and temple defects can be repaired by primary closure, skin flaps, skin grafts, tissue expansion, and healing by secondary intention. Fullcolor clinical photographs and line drawingsalong with highquality surgical video clipscapture the latest facial reconstruction practices and effective methods like reconstruction of skin defects on. Dec 30, 2019 the nose is a central, defining feature of the face, and abnormalities of the nasal structure are readily apparent even to an untrained observer.
The lateral forehead flap is based on the anterior division of sta and inclusion of zygomatic branch further improves vascularity of the flap 4. Of these 25 patients flaps, only 15 patients showed flap related complications. Any author who is considering writing an article should submit the title to ronald l. I would like to report an unusual complication pertaining to forehead flap repair of a nasal defect. Congestion to the skin paddle seems to be the biggest drawback, although subsequent thinning can be performed. Kaleem ansari 1 1 department of oral and maxillofacial surgery, dr. The paramedian forehead flap is based on the supratrochlear artery the supratrochlear artery is reliably located 1. This increased tendency for infection with complete forehead flap may be related to the large surface area of the flap exposed. Forehead plasty for facial rejuvenation aesthetic surgery. Preliminary stages before nasal reconstruction using forehead. Ziauddin ahmad dental college, aligarh muslim university, aligarh, uttar pradesh, india 2 department of oral and maxillofacial surgery, rwth aachen university, aachen, germany. Previous radiation to the donor site is a relative contraindication. Pdf the forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction.
Achieve optimal results in reconstructive surgery involving flaps and grafts with this uptodate reference written by leading dermatologic surgeons. It involves taking skin from the forehead called a flap with its own blood supply and attaching it to the nose to replace the missing skin. We describe a novel reconstructive method for half forehead defects with an innovative single local wide scalp flap following excision of dfsp with a 3 cm margin of healthy tissue. Local flaps in facial reconstruction brings you the detailed visual guidance and unmatched expertise you need to achieve the best results for the full range of facial flap procedures. The forehead flap has been used for many centuries and remains a workhorse. For difficult areas such as those involving the medial canthus or the eyelids, the flap was rotated toward the defect for repair of the medial canthus, anterior lamella of the lower eyelid, and the side of the nose. Often used as an interpolated flap for nasal defect reconstruction. Our experiences syed s ahmed 1, alireza ghassemi 2, sajjad a rehman 1, md. Versatility of forehead flap in maxillofacialnasal and. Flaps and grafts in dermatologic surgery 2nd edition. The paramedian forehead flap is a great option for restoration of. In all cases, the median or paramedian pedicled forehead flap was the main method of surgical reconstruction. A forehead flap reconstruction is a surgical technique used to repair a wound on the nose. Overview of local flaps of the face for reconstruction of.
In all endoscopie brow lifts, permanent fixation is achieved by scarring under the entire broad surface of the repositioned forehead flap. Jagdeep k rao, kaustubh sharad shende department of plastic surgery, sms medical college, jaipur, rajasthan, india click here for correspondence address and email. Reconstruction of the medial canthus using an ipsilateral paramedian forehead flap article pdf available in archives of plastic surgery 406. Surgical excision with forehead flap as single modality. Furthermore, because the forehead flap is an interpolated flap requiring careful dissection and complicated inset, patients may experience extensive operating times. Using a systematic approach, flaps and grafts in dermatologic surgery, second edition, by drs. In our cases we have used lateral forehead and pmmc flap to cover the defect. Paramedian forehead flap nasal reconstruction surgical technique. In summary, the singlestage forehead flap remains a useful tool in the armamentarium but is used less frequently now than previously. Blood supply of pectoralis major flap figures 2, 3 the pectoralis major flap is an axial flap and is based primarily on the pectoral branch of the thoracoacromial artery and the thoracoacromial artery is a branch of the axillary artery, itself a continuation of the subclavian artery. It is an axial flap based on the anterior and posterior deep temporal arteries.
Paramedian forehead flap nasal reconstruction alar rim. The temporalis muscle flap johan fagan the temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. It is done in two or three stages over a period of weeks or months. The crossparamedian forehead flap nejm journal watch. Paramedian forehead flap iowa head and neck protocols. The median forehead flap is the mainstay for repairing nasal defects larger than 2 cm. It is a composite flap and comprises muscle, overlying fascia and skin.
Anyhow, the total loss of flap leading to alternate flap was in only 1 case 4%. In addition to presenting the latest principles and techniques, this new resource also examines evolving concepts and methods, keeping you at the forefront of todays practice. Purchase flaps and grafts in dermatologic surgery 1st edition. The paramedian forehead flap pmff is a versatile pedicled flap with a robust vascular supply, based upon supratrochlear artery, that is well suited for reconstruction of complex or large nasal defects. The two flaps are oriented perpendicularly to each other.
This shows a higher success rate of forehead flap in maxillofacial region. New twist on centuryold plastic surgery technique helps. Pushing the limits of the forehead flap shows that it is robust and reliable. Rather than use a traditional flap that straddles the entire glabellar region, most surgeons use a paramedian forehead flap variation based on the supratrochlear vessels. The rutgersled solution took a paramedian forehead flap an ageold procedure in which a section of skin and muscle. Total flap failure was recorded in 2 cases 1 complete and 1 partial forehead flap. Aesthetic considerations in forehead reconstruction in skin carcinoma 21.
Half forehead reconstruction with a single rotational scalp. Several authors have described the use of lateral forehead flap for oral mucosal lining as well as for skin cover. What is the optimal timing for dividing a forehead flap. The authors present three cases in which a dualplane modified a to t flap is used to reconstruct central and lateral forehead defects up to 8 cm in size with excellent aesthetic results. Forehead galeal pericranial flap for singlestaged total upper eyelid reconstruction in sebaceous gland carcinoma excision huihsiu chang,1,2 edward suh,3 blake h fortes,3 franklin zheng,3 anny ms cheng3,4 1division of plastic and reconstructive surgery, department of surgery, national taiwan university hosiptal yunlin branch, yunlin, taiwan.
Theory and practice teaches a systematic approach for successful surgical management of facial defects. We read with great interest the article entitled simplifying the forehead flap for nasal reconstruction. The authors retrospective analysis of patients who underwent nasal reconstruction was exemplary for plastic surgeons. Our experience and surgical technique using the forehead flap are described. This can be changed as needed for the first 10 days after which probably no further dressings are required. The forehead flap for nasal reconstruction dermatology jama. Preliminary stages before nasal reconstruction using forehead flap. The code is 15731 forehead flap with preservation of vascular pedicle e. Concepts of sliding and lifting tissue movement in flap reconstruction. Scalp and forehead defects, if treated adequately, can heal with stable and aesthetically acceptable results. Here we discuss the management of bccs of central face with surgical excision and reconstruction with forehead flap as single modality treatment. Paramedian forehead flap for nasal tip reconstruction after. The forehead flap delivers a large amount of tissue so.
Pdf usage of a rotational flap for coverage of a large. In my opinion, the gold standard for forehead plasty remains the open approach, which affords the surgeon the opportunity for direct visualization, palpation of anatomical structures, adjustments, and appropriate excision without the necessary use of cortical screws, bone tunnels, and other devices to assure frontal flap fixation. Elegant solutions for complex paramedian forehead flap. Paramedian forehead flap after mohs surgery karenzupko. Forehead galeal pericranial flap for singlestaged total. You should not need a modifier because you are a different specialty plastic surgery from the mohs surgeon dermatology and payers should not consider you to be in the mohs surgeons global period.
Failure of the median forehead flap occurred post division despite a timing period of 36 days prior to division. The reconstruction of nasal soft tissues with the forehead flap is the gold standard and this method was used in the case of our patient 9. The flap edges are then trimmed to fit the defect better, and the flap is inset. Kaufman, offers practical, easily accessible guidance in this challenging area, including anatomical. Flaps and grafts in dermatologic surgery 1st edition. Two patients underwent wide resection of forehead dfsp and reconstruction with a single rotational scalp flap. Anatomically, the nose consists of a thin mucosal lining, sculptured alar tip cartilages, bone and cartilage braces that buttress the dorsum and sidewalls, and a thin vascular canopy of skin that matches the adjacent facial skin in color, texture. Unusual complication of a forehead flap, dermatologic.
The skin grafted segment of the forehead flap will be removed during your second stage surgery. Paramedian forehead flap combined with hinge flap for. However, use of free flaps is technique sensitive, involves prolong procedure, require extensive postoperative monitoring, may be relatively. Oct 26, 2015 forehead flap in maxillofacial surgery. Conclusions the forehead flap represents one of the best methods for repair of. He was on lansoprazole, amlodipine, and sertraline.
His medical condition included cerebrovascular disease, confusion, and unsteadiness. This manuscript was accepted for publication on february 6, 2020. Paramedian forehead flap for nasal tip reconstruction after mohs surgery the paramedian forehead flap is a great option for restoring complex nasal defects. The maximal width of the flap is determined by a pinch test to assess how much donor site can be closed primarily. Given the ideal quality of color and texture, the forehead skin is recognized as the best donor site for resurfacing the nasal defects. A new technique for simultaneous lining and cutaneous reconstruction in case of full thickness defects of the nose.
Concepts of sliding and lifting tissue movement in flap. Simplifying the forehead flap for nasal reconstruction. Nasal reconstruction using paramedian forehead flap. Overview of local flaps of the face for reconstruction of cutaneous malignancies. The importance of this flap is due to its versatility since. The skin graft on the forehead flap to your nose will also have a xeroform dressing on it as well as an ointment called polysporin. The submental flap is generally raised before lymphadenectomy.
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