The Importance of Expanded Forehead Flap in Nasal Reconstruction

Ismail, Karima T.; Ismail, Mariam T.; Ismail, Ahmed T.

doi:10.21608/ejprs.2020.112462

The Importance of Expanded Forehead Flap in Nasal Reconstruction

Document Type : Original Article

Authors

The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University

10.21608/ejprs.2020.112462

Abstract

Introduction: Nasal reconstruction is a difficult problem
because it entails reconstruction of skin, cartilage, osseous
frame work and lining mucous membrane [1]. The result must
be satisfactory both cosmetically and functionally [2].
The anatomical reconstruction depends on the principle
of subunit divisions of the nose. Which states: If the reconstruction
is less than the defective subunit the result will
appear patchy. On the other hand, if the reconstruction exceeds
the limits of the subunit the nose will appear unnatural [3,4].
Local and regional flaps are used in nasal reconstruction
each type has its own advantages, disadvantages and donor
site morbidity [5-9]. The aim of this work is to demonstrate
the advantages and disadvantages of expanded forehead flap < br />in nasal reconstruction.
Material and Methods: A retrospective review of 25
consecutive cases of total or nasal dorsum reconstruction who
were operated upon in a single clinic by 3 separate surgeons
adopting the same principle of expanded forehead flap, between
January 2010 and January 2017.
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 [10].
Results: Surgical follow-up varied from a minimum of 6
months to a maximum of 2 years with average follow-up of
1 year. Among a total of 25 patients, 23 patients (92%)
complied with follow-up, and 21 (91%) of these patients were
satisfied. One case only complicated and the expander extruded
and had to be removed.
Conclusion: The tint of forehead skin is similar to nasal
skin. Forehead flap is well vascularized and is lying adjacent
to the nose. Forehead is a multilaminar structure which allow
the usage of skin grafts as inner lining and because of its high
vascularity all types of structural support can be used.
Expanded forehead flap provides large, excess forehead skin
and primary closure of donor site is applicable. During the
process of expansion, the skin is thinned out so do not need
de-fattening and re-contracture do not occur. Therefore,
forehead flap is always a good reconstructive option in large
nasal defects.

Keywords

Main Subjects

Aesthetics

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