Download as pptx, pdf, txt or read online from scribd. Method the forehead flap was applied to reconstruct the defects of the posterior hypopharyngeal wall, external perioral skin and buccal mucosal, and nose and periorbital tissues after. Postoperative instructions following forehead flap nasal. The surgical technique was complemented with results from the. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. Dermatofibrosarcoma protuberans dfsp is a soft tissue neoplasm of intermediate to lowgrade malignancy. The long arms of the flap are usually placed in existing wrinkle lines. Ideally, its scars blend into the normal frown lines.
The defect as in this case is 3cm to 4cm and therefore the paramedian forehead flap was. In all cases, the median or paramedian pedicled forehead flap was the main method of surgical reconstruction. Radio host shows off forehead flap to warn others about. Do i code 15620 since the flap was brought from the forehead, or.
This surgical video demonstrates the second stage of a nasal tip reconstruction, using a paramedian forehead flap, carried out by professor tim woolford of manchester. This video clipping is from one of my surgeries performed in the early years of my surgical practice it is being uploaded since i realise that forehead flap, though a workhorse for head neck. Pdf the forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction. To obtain a longer flap, auvert, in 1850, slanted it across the forehead at an oblique angle of 45 degrees. Objective to evaluate functional and aesthetic results of periorbital defect repair using forehead flaps. Skin flap surgery is done to cover a deep or large open wound, or repair damaged skin. The cheek flap scar is hidden in the smile line while the forehead flap creates a vertical scar above the inner portion of the brow. 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. The disadvantages of this flap are that the supraorbital nerve has to be severed, an asymmetry of the eyebrows may be left and sometimes a dog ear at the level of the eyebrows has to be corrected at a second stage under local anesthesia.
Skin cancer surgery information sheets forehead flap. Central forehead defects should be assessed for both horizontal and vertical tissue tension. Marks have also been made in the wrinkles of the forehead to aid in the subsequent closure of the donor site. Reconstruction using the above mentioned technique is a useful. Quatela, 1995 had used the paramedian forehead flap for the defects larger than 1. The forehead flap is a useful technique to reconstruct deep and large nasal defects. The forehead is the anterior region of the vertebrate skull and extends, in man, from the hair bulb to the eyebrow.
Elegant solutions for complex paramedian forehead flap. Surgical excision with forehead flap as single modality. Although metastasis rarely occurs, dfsp has a locally aggressive behavior with a high recurrence rate. We have found it to be an excellent flap option for forehead defects for several reasons. The patient had a large nasal defect created by mohs surgery for resection of a recurrent basal cell carcinoma. Lateral forehead based on right sta was raised for skin cover. Reconstruction with a forehead flap following mohs surgery. The excellent blood supply to this flap makes the vertical midforehead flap extremely. This is like a local skin flap, except tissue is taken from a little further away such as the forehead or cheek. Sterile technique and preoperative antibiotic administration can.
It is the preferred method for covering nasal defects too large to be repaired with fullthickness skin grafts, nasal cutaneous flaps, composite auricular grafts, or interpolated melolabial flaps. Singlestage forehead flap in nasal reconstruction gary m. Authors personal copy nasal reconstruction with a forehead flap. Historically, the paramedian forehead flap has been used for reconstruction of larger defects of the nose. Reconstruction of large scalp and forehead defects following tumor resection reconstruction of large scalp and forehead defects. The use of paramedian forehead flap reconstruction after. This portion of the flap will swell and become distended with tissue edema.
Forehead flap for simultaneous reconstruction after head. These techniques were modified further and popularized by other surgical giants. In the first surgery, the flap is left attached to its original blood supply. Previous forehead or orbital trauma or surgery with likely interruption of the blood supply of the flap tissues is a contraindication. Forehead flap reconstruction nathan todd nelson schreiber, md, steven ross mobley, md elegant solutions are frequently sought by both artists and engineers.
Understand current developments in the use of intranasal. Application of different expanded forehead flaps for cervicofacial. A forehead flap is usually required if the nasal defect is larger than 1. This technique has allowed primary placement of both cartilage alar grafts and dorsal nasal bone grafts simultaneously at the initial repair of fullthickness defects. The forehead flap is used when the nasal defect is deep, extensive or requires lining replacement or cartilage support. A new technique for simultaneous lining and cutaneous reconstruction in case of full thickness defects of the. Nasal reconstruction using a paramedian forehead flap.
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. Often used as an interpolated flap for nasal defect reconstruction. Facial and eyelid reconstruction after mohs surgery. The rectangular advancement flap is the repair of choice for most moderatesized defects of the central forehead fig. One end of the skin flap often remains attached to the donor site and to its blood supply. In particular, the colour and texture of the forehead skin matches exactly with the skin of the nose, which is why the forehead flap is. Half forehead reconstruction with a single rotational. Interpolated paramedian forehead flaps pocket dentistry. Median forehead flap with revision university of iowa. General anesthesia can make you feel groggy for up to 48 hours after surgery. Skin flap surgery discharge care what you need to know. Both tend to heal nicely but the choice of the best flap depends upon the size and location of the nasal defect as opposed to the location of the scar.
The blood vessels in the skin are called a pedicle. The classic procedure involves a secondstage operation to divide and inset the external pedicle. Forehead flaps are 2stage tissue flaps in which a foreheadbased pedicled flap. Two 8% cases of partial flap necrosis and 1 case 4% of partial graft loss. Forehead flap raised with right lateral pedicle and the defect to be covered. After studying this article, the participant should be able to. Millard, in the 1960s and 1970s, used a characteristic gullwing design with lateral extensions for alar reconstruction and extended the pedicle incisions below the brow to provide. Potential complications with the use of the forehead flap. A forehead flap is a reconstructive operation most commonly following a mohs surgery for patients who have lost a significant amount of their nose to cancer. Aesthetic considerations in forehead reconstruction in. Donor site aesthetic enhancement with preoperative. Esthetic refinements in forehead flap nasal reconstruction. Forehead flap for buccal mucosamarginal mandibulectomy.
Reconstruction of large scalp and forehead defects. Flap survival, functional results, and postoperative complications were. The esthetic and functional results of nasal reconstruction with the paramedian forehead flap are given in table 3. Kazanjian advanced the development of the forehead flap by advocating primary closure of the forehead donor site. Second stage nasal reconstruction division of forehead flap. Pmmc flap was raised in standard fashion with skin paddle of 7. The paramedian forehead flap may be one of the oldest flaps in use for the reconstruction of facial defects. An incision is made along the planned median forehead flap with a 15 blade.
In the head and neck area, resection involving a wide margin of healthy tissue can be difficult because of functional and cosmetic considerations. Its use in nasal reconstruction dates as far back as 1500 bc as it was used to reconstruct nasal amputation defects. This video demonstrates repair of a medial canthal defect via a median forehead flap and the subsequent revision of the flap. Forehead flap was delayed after 6 weeks of surgery and final detachment and insetting was done in 7. Nasal skin basal cell carcinoma forehead flap html5. If there is a dressing in place, leave this on until your first post operative visit.
A 10year experience in nasal reconstruction with the. Methods a retrospective study of 10 cases of nasal reconstruction with midforehead flap, between 1991 and 2012, was performed. Anterior abdominal wall crossectional anatomy and arcuate line when harvesting a rectus flap, the anterior rectus sheath is incised vertically over the midportion of the rectus muscle, whereas the posterior sheath is preserved. A dual flap combining lateral forehead and pmmc flap is a useful approach. Results the forehead flap was used to repair 147 nasal defects after mohs excision of nonmelanoma skin cancer. On these rare occasions, the forehead flap is a threestage procedure rather than a twostage procedure. The flap has been used extensively in nasal reconstruction. It provided insight into the nature of wound injury and healing, permitted the use of both primary and delayed cartilage grafts, and increased the opportuni. A forehead flap reconstruction is a surgical technique used to repair a wound on the nose. A skin flap is a portion of skin that is moved from one area of the body to another. Pdf one stage forehead flap for nasal reconstruction. The area the skin flap will be taken from is called the donor site. We recently demonstrated the cosmetic benefit of botulinum toxin type a btxa for cleft lip cheiloplasty outcomes.
The forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction. The paramedian forehead flap is based on an axial blood supply from the supratroch lear artery, which exits the orbit 1. The characteristics of defects repaired with the forehead flap and the need for lining andor cartilage were examined. Donor site scarring after forehead flap nasal reconstruction is acceptable. Understand the history of nasal reconstruction and its implications to modern nasal repair. A needle tip cautery is then used to dissect along the surface of the periosteum. Do i code 15620 since the flap was brought from the. Now, the djs face is almost completely back to normal you can hardly tell she ever had a hole in her nose. While it looks a bit ghoulish following the first surgery, please remember that it is only temporary. Called as lifeboat may be raised quickly to get surgeon out of trouble. The use of forehead flaps in the management of large basal. 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. Conversely, the forehead flap can be transferred as a singlestage procedure on select individuals eg. Final pedicle division occurs as a third stage 3 weeks later.
If the defect is small and superficial it can be resurfaced with a skin graf or it can heal by secondary intention. This study aims to demonstrate the versatility of the flap in the midforehead flap in extensive nasal reconstructions, but it requires repeated surgical refinement process until we get adequate support and contour. It is done in two or three stages over a period of weeks or months. Paramedian forehead flap iowa head and neck protocols. The color and texture closely match that of the nose and the scar left behind on the forehead is either minimal or easily hidden. Previous radiation to the donor site is a relative contraindication. 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. My doctor did a division and inset of a paramedian forehead flap on a patient that had mohs surgery on their nose. Use of the bipedicled scalp flap for forehead reconstruction. On december 26, 2017, janet had a second surgery to remove the forehead flap.
This is performed to an area 2 cm above the root of the nose. In dance, for example, elegance is defined by the minimum amount of motion that results in the maximum visual effect. Pmmc and lateral forehead flap was used for reconstruction. The forehead flap is known as the best donor site for repairing nasal defects because of its size, superior vascularity, skin colour, texture and thickness.
Keep yourself hydrated with water, 7up, gatorade, or other sports drinks. Skin taken from the forehead has long been a donor of choice for major nasal repair. The wound and stitches are usually not bandaged, just covered with a layer of antibiotic ointment. Fullthickness skin was lost in all cases, structural skeletal support in 68 cases 46%, and internal mucosal. The forehead flap for nasal reconstruction dermatology. Provision of stable tissue, non hair bearing, similar colour tissue maintaining proper positionshape of the eyebrows preservation of smoothcontinuous anterior hairline planning incisions along the rstls, hairlines, vertical in the glabella goals of forehead reconstruction. Forehead flap periorbital reconstruction external eye.566 340 1132 1476 663 1401 961 664 1520 1563 407 412 462 1288 370 656 1055 632 569 1239 807 1247 1118 967 728 197 462 1493 281 1216 132 451 193 1191 970 1180 449 1474