Median Forehead Flap

The median forehead flap is used to reconstruct larger defects of the nasal dorsum, sidewall, and tip. The flap receives its blood supply from the su-pratrochlear artery on one or both sides (Fig. 5.15b). These vessels can be identified with a Doppler probe. The forehead should be high enough to permit the end of the flap to reach the nasal tip (using a pattern as a guide). The width of the flap should not exceed 3-3.5 cm so that the donor defect in the forehead can be closed primarily without special preparations. The flap can be used immediately owing to its excellent blood supply. The medial vertical scar in the forehead can be dispersed with a primary Z-plasty or W-plasty (see pp. 6 and 8). If the flap is broad resulting in a tense suture line, we prefer secondary revision of scars that are still conspicuous 1 year after the operation.

The flap incision can be made through all layers down to the level of the eyebrow (Fig. 5.15a). In the glabellar area, the flap is bluntly dissected with a sponge stick or curved clamp to expose and preserve the artery on one or both sides (Fig. 5.15b). The skin incision can then be continued down below the brow level. If one artery is lost, the second artery generally can ensure adequate flap perfusion. The residual triangular defect in the inter-brow area (Fig. 5.15c) is covered with meshed tulle or a similar dressing. About 17-20 days are needed for the forehead flap to take at the recipient site (Fig. 5.15d). At that time its pedicle is divided and inset into the triangular interbrow defect, which is first cleared of granulation tissue (Fig. 5.15d). The interbrow wound should not be reapproximated at the time of flap transfer, as this would distort the eyebrows by drawing them toward the midline. The wound edges should be freshened prior to inset of the flap pedicle.

Fig. 5.15 Median forehead flap.

a Outline of the median forehead flap, which is based on one or both supratrochlear arteries. The maximum flap width is 3.5 cm. b The flap is dissected, leaving the galea and periosteum on the bone. If necessary, a split-thickness or full-thickness skin graft or composite graft (L) can be attached to the distal end of the flap. c The flap is sutured into the tip defect and the forehead wound is closed, leaving a wedge-shaped defect between the eyebrows. d The flap has been detached and its inset completed. The pedicle is reimplanted in the interbrow area 3-4 weeks later.

Median And Paramedian Flaps

Fig. 5.16 Straight and oblique forehead flaps of varying sizes. a Paramedian forehead flap based on one supratrochlear artery.

b Closure of the defects. c About 20 days later the flap is detached and the pedicle returned (see Fig. 5.15). d Oblique forehead flap. The flap width may exceed 3.5 cm, but this precludes a simple direct closure of the secondary defect (see Figs. 4.2-4.5).

Flap Surgery

Fig. 5.16 Straight and oblique forehead flaps of varying sizes. a Paramedian forehead flap based on one supratrochlear artery.

b Closure of the defects. c About 20 days later the flap is detached and the pedicle returned (see Fig. 5.15). d Oblique forehead flap. The flap width may exceed 3.5 cm, but this precludes a simple direct closure of the secondary defect (see Figs. 4.2-4.5).

As in all operations, meticulous hemostasis is required.

The flap takes from 6 months to 1 year to heal completely. If it is too thick or if unsightly scars have formed, the flap may be thinned (defatted) and/or the scars revised by means of small Z-plasties or W-plasties (see pp. 6, 8). For larger defects, we recommend using 50-100-mL tissue expanders on one or both sides (see Fig. 4.5) before raising the median or oblique forehead flap.

Modifications are asymmetric, paramedian forehead flaps (Fig. 5.16a-c) and oblique forehead flaps (Fig. 5.16d).

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment