Median Forehead Flap with Soft Tissue Expansion

In this technique the median forehead skin is expanded with a 200-mL envelope for 6-8 weeks, and then a forehead flap is incised to match the nasal defect (Fig. 5.53; Siegert et al. 1992, 1994; see also Fig. 5.49 and Fig. 5.16, oblique forehead flap).

b The forehead flap is inset into the defect over silicone stents (lining see text). Closure of the donor defects is the same as with the Converse scalping flap (Figs. 5.50 and 5.51 e, f).

Median Forehead Flap

Fig. 5.52 Sickle flap of Farrior (1974).

a The lower portion of the sickle flap is a median forehead flap at least 8 cm wide. It is supplied by a "transport flap" incised in the scalp and based on the superficial temporal artery (the galea remains intact).

b The forehead flap is inset into the defect over silicone stents (lining see text). Closure of the donor defects is the same as with the Converse scalping flap (Figs. 5.50 and 5.51 e, f).

Forehead Flap

Fig. 5.53 Broad median forehead flap following preliminary soft-tissue expansion with a 200-mL expander. A small incision in the scalp gives access for inflating the envelope. The flap is dissected from the galea and periosteum in a subcutaneous plane, preserving the frontalis muscle (oblique forehead flap, see Fig 5.16). Better results without a rigid scar we can get with lateral expansion (see Fig. 4.5).

Fig. 5.53 Broad median forehead flap following preliminary soft-tissue expansion with a 200-mL expander. A small incision in the scalp gives access for inflating the envelope. The flap is dissected from the galea and periosteum in a subcutaneous plane, preserving the frontalis muscle (oblique forehead flap, see Fig 5.16). Better results without a rigid scar we can get with lateral expansion (see Fig. 4.5).

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