Im so scared of the forehead flap because its so gruesome looking but i feel like the cosmetic outcome is better than the cheek flap i dont want a scar, even if its in my smile line. Results the forehead flap was used to repair 147 nasal defects after mohs excision of nonmelanoma skin cancer. Purchase local flaps in facial reconstruction 3rd edition. 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. For both sides of midfacial reconstruction, type iii flap can be employed. Called as lifeboat may be raised quickly to get surgeon out of trouble. The forehead flap is one of the oldest recorded surgical techniques for nasal.
Our experience and surgical technique using the forehead flap are described. Because the operation is performed under general anaesthesia without local anaesthesia, the flaps colour and capillary refill can be evaluated. Usually the notch of the supratrochlear vessels is palpable and that is where the skin pedicle is centered. It is ideal in frail patients with good softtissue laxity and provides an immediate onestage reconstruction with ideal skin color, texture, and thickness matches for large forehead and temple. It is done in two or three stages over a period of weeks or months. In this operation a reconstructive surgeon uses skin from the forehead above the eyebrow and pivots it vertically to replace missing nasal tissue. History of total nasal reconstruction with particu. Although written texts from 6thcentury bc india through 16thcentury ad europe described pedicle flap repair of nasal defects, it was not until the late 18th century that the first written description of the forehead flap appeared. Arising from the ophthalmic branch of the internal carotid system, the supratrochlear artery supplies the midline forehead flap.
Nasal reconstruction using a paramedian forehead flap is a surgical technique to reconstruct different kinds of nasal defects. This article explores the history of forehead flap surgery, contemporary concepts in flap design, surgical steps, and potential complications. The forehead flap is known as the best donor site for repairing nasal defects because of its size, superior vascularity, skin color, texture and thickness. Application of different expanded forehead flaps for cervicofacial. Paramedian forehead flap case example iowa head and neck. The paramedian forehead flap has been used for centuries in nasal recons truction. As the gold standard for nasal soft tissue reconstruction, the forehead flap provides a reconstructive. To most laypeople the operation at first may seem a bit unusual but in actuality it has been a standard operation in the. Prelamination of a forehead flap to repair fullthickness defects has limited application, but it can be useful for 1. Results the forehead flap was used to repair 147 nasal defects after mohs.
At this point, the forehead flap can be divided from the eyebrow as the skin can now survive on the nose. Nasal reconstruction has seen significant advancements in the modern era, though forehead flap surgery itself is not new. Central forehead defects should be assessed for both horizontal and vertical tissue tension. A split forehead flap for the treatment of resistant. The tunneled forehead flap in medial canthal and eyelid reco. Beetle bailey is an american comic strip created by cartoonist mort walker, published since september 4, 1950. In the elderly or debilitated patient although prefabrication adds an operative stage, the placement of preliminary skin and cartilage grafts and subsequent flap transfer and division are relatively modest procedures. I used the classical median forehead flap to reconstruct the nose. Highest quality treatment and services with longlasting results. Background the midline forehead flap is used in the reconstruction of large, deep defects of the. Im 18 days post forehead flap surgery to fix a nose defect. The impact of indian methods for total nasal reconstruction. The rectangular advancement flap is the repair of choice for most moderatesized defects of the central forehead fig.
Principles of nasal reconstruction, second edition, is a comprehensive. He also wrote books on anatomy, surgery and physiology and a large monograph. Note in particular that the head of the left brow is shifted medially as well as inferiorly. Probably the first nasal reconstructions using a forehead flap were performed by sushruta in india during 600 to 700 bc. The story, however, has a tragic ending, a week later the boy was readmitted with severe. Oct 07, 2018 the lining deficit would be replaced with an extension of the forehead flap or by hinging over the previous forehead flap for lining. Written by three experienced consultants with a large skin cancer practice and international reputations for excellence, this book provides comprehensive practical solutions to defects in the head and neck region that are confronted by the clinician in daytoday practice. Paramedian forehead flap for complex nasal defects following. Postoperative complications of paramedian forehead flap. Unilateral defects are more easily resurfaced with the ipsilateral flap because its pedicle is closer to the defect. In the years just before walkers death in 2018 at age 94, it was among the oldest comic strips still being produced by its original creator. Flaps and grafts in dermatologic surgery 2nd edition. The portion of the nose to be covered should be first measured with a leaf. Two stage forehead flap ala reconstruction for large.
Over the next 34 weeks the flap learns to live from the nose, and new blood vessels from the nose grow into the flap skin. Forehead flaps are a surgical procedure that is mainly used to repair nasal defects. Pdf local flaps in head and neck reconstruction download. 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. Features that distinguish it from other flaps include the availability of skin, the accurate color and texture match, and time tested dependability. May 26, 2017 this video demonstrates a second stage median forehead flap. Local flaps in facial reconstruction book description. The singlestage forehead flap in nasal reconstruction.
Kaufman, offers practical, easily accessible guidance in this challenging area, including anatomical. Flap classification and local facial flaps facial plastic. The forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction. The forehead is thicker than nasal skin and excessive subcutaneous fat and frontalis muscle must be excised to create a skin flap of a thickness similar to that of the missing skin of the nose. Nasal reconstruction using a paramedian forehead flap wikipedia. A 10year experience in nasal reconstruction with the three. Additionally, for patients with smoking history, local radiation therapy, or a large amount of ti. The forehead flap is kept attached to the eyebrow, as this is how the blood flows in and out of the flap. Over the years, mort walker had been assisted by among others jerry dumas, bob gustafson. Longterm effects provide a good color match, inconspicuous scars and preferred nasal shape without excessive bulk.
The median forehead flap is a unipedicle flap used to close large anterior lamellar defects of the lower eyelid and medial canthus fig. Following 120180 of rotation into the defect, the flap is secured with a twolayered closure. The forehead has served as a source of tissue for nasal reconstruction for centuries and many different flaps have been designed with distinct advantages and disadvantages. Covers the latest topics in reconstruction including threestage forehead flap repair of. Tribhovandas published his work in 1888 in the indian medical gazette, and then a monograph on the subject in 1889. Jun 05, 2020 forehead flaps are surgery to repair nasal defects. Three stage forehead flap for large partial thickness defect. The forehead flap for nasal reconstruction dermatology jama. This article explores the history of forehead flap surgery, contemporary concepts in.
Jul 21, 2014 hello, i have been given the option of a forehead flap for my mohs on nose reconstruction. However, there is a misconception that this surgery began with the forehead flap repair, and the history of the subsequent two and a half millennia is poorly represented in most surgical texts. In time, the median forehead flap was developed for the purpose of total nasal reconstruction 17 fig. Nasal reconstruction with paramedian forehead flap plastic. Achieve optimal results in reconstructive surgery involving flaps and grafts with this uptodate reference written by leading dermatologic surgeons. This dacoit robbed, raped and cut off peoples noses. The tint of forehead skin so exactly matches that of the face an. The book emphasizes the restoration of nasal defectsfrom simple to. A useful flap because of the axial design, narrower base, and greater effective length.
Reconstruction with a forehead flap following mohs surgery our goal is for you to have a successful surgical outcome. Its roots trace back to india, where the rudimentary version of todays forehead flap was employed as a reconstructive modality following nasal amputations as a form of punishment. Centurythey are the reconstructive mainstay for nasal defects. Supratrochlear artery an overview sciencedirect topics. Especially the color and texture of the forehead skin matches exactly with the skin of the nose.
The source of development of the forehead flap for nasal reconstruction is unclear in indian history, but has been performed since 1440 a. May 17, 2019 the forehead flap has been a staple in nasal reconstructive surgery dating back to 700 b. Figure 5 ackernecht has aptly observed there is little doubt that plastic surgery in europe which flourished in medieval italy is a direct descendant of classical indian surgery. This is why the forehead flap is used so much for nasal reconstruction. Pedicled forehead flap for the reconstruction of maxillary. I had forehead flap surgery after melanoma was removed from my nose in jan. Nasal reconstruction, first described over 2600 years ago in india, has undergone several modifications in its development. Small nasal defects may be resurfaced in two stages with a forehead flap but large deep defects are best repaired in three stages with an intermediate operation which allows the placement of primary and delayed primary cartilage grafts, soft tissue sculpting, and folded flap lining replacements with safety. Paramedian forehead flap iowa head and neck protocols. The exact dimension and outline of the missing nasal skin which will be replaced with the forehead flap is designed using the alar template. The method was introduced in europe in the 15th century. A forehead flap reconstruction is a surgical technique used to repair a wound on the nose.
A forehead flap that takes advantage of the vascular supply of the supratrochlear artery. Jan 27, 2021 the forehead flap has been used for many centuries and remains a workhorse flap for major nasal resurfacing. A forehead flap can be extensively reelevated towards the nostril margin and the columella inset. A novel advancement flap for reconstruction of massive. The history of nasal reconstruction is intertwined with the history of plastic surgery.
This is probably the oldest flap in history and still has a place today. Nasal reconstruction with paramedian forehead flap. Reconstruction with a forehead flap following mohs surgery. The first english description of the indian midline forehead rhinoplasty was published in the madras gazette in 1793 and later carpue, an english surgeon, published his experience with two successful median. Sushrutas treatise provides the first written record of a forehead flap. However, this change allows the book to deliver more. Second stage median forehead flap university of iowa. The paramedian flap is perfused by the supratrochlear vessels and can be based on either side of the forehead. This flap produces an excellent tissue color and texture match for nasal reconstruction.
After this i had reason to use the median forehead flap or the indian method as it was often called on several occasions and i began to search the history of this very useful procedure. 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. Chapter 6 a modern approach to nasal reconstruction with a forehead flap. Latest cuimc covid19 news eligible patients can now book vaccine. Local flaps are best used when the defect is superficial and less than 1. Book from statpearls publishing, treasure island fl, 22 dec 2017. He also wrote books on anatomy, surgery and physiology and a large monogr. The forehead flap procedure can take months to heal, depending on procedure types and the underlying condition of the patient. Jul 21, 2016 the paramedian forehead flap pmff is a robust, wellestablished technique for reconstruction of large nasal defects. Threestage forehead flap enables sculpting in complex. The hairline, frown lines, and subunits of the nose and lip were marked with ink to identify the outline of the subunits, old scars, the old flap and important landmarks fig. The patient had a relatively deep right cheeknasal wall defect which was repaired approximately 2 months previously. Second stage nasal reconstruction division of forehead flap.
The paramedian forehead flap is based on the supratrochlear artery the supratrochlear artery is reliably located 1. Forehead flaps in nasal reconstruction were first detailed in an indian work entitled sushruta samita over 2000 years ago. Forehead flap periorbital reconstruction archives of. Forehead flap surgery is used to repair nasal defects. The history of nasal reconstruction can be traced as far back as 600 to 700 bc in.
Pedicled forehead flap for the reconstruction of maxillary defect. Chapter 11 restoring the nasal lining an historical overview and modern indications. 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. Atlas of regional and free flaps for head and neck reconstruction book description. Using a systematic approach, flaps and grafts in dermatologic surgery, second edition, by drs. Nasal reconstruction using a paramedian forehead flap. A novel surgical case report sudipto sahu 1, subrat padhiary 2, rajarshi banerjee 1, sucharu ghosh 1 1 department of oral and maxillofacial surgery, haldia institute of dental sciences and research, west bengal university of health sciences, haldia, west bengal, india 2 department of oral and maxillofacial surgery, institute of. Either the right or left pedicle can be chosen for midline defects. In sushruta samhita he describes the freegraft rhinoplasty as follows. The contralateral alar template is a mirror image of the missing ala and must be flipped over 180 to correctly orient the flap to the recipient site. In hemi facial resurfacing, a novel method was performed using the. The forehead flap remains the workhorse for major nasal reconstruction and has undergone numerous modifications since its early inception 4.
A split forehead flap was used to definitively correct his ectropion. Post operative period was uneventful and patient recovered well fig. Although the excessive soft tissue can be excised at the time of harvest, in larger more complicated defects it is safer to thin the excess during an intermediate operation prior to pedicle division. I found that its origin lay in antiquity, and could be traced back to the great indian ayurvedic surgeon sushruta. Fullthickness skin was lost in all cases, structural skeletal support in 68 cases 46%, and internal mucosal lining in 45 cases 31%. The extended lateral forehead flap jurnal plastik rekonstruksi. Forehead flap periorbital reconstruction archives of facial. Oct 14, 2019 the paramedian forehead flap pmff is an interpolated axial flap based primarily off the supratrochlear neurovascular system and is well suited for reconstructing complex defects of the nose. This atlas depicts in a clear manner the use of regional skin, muscle and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred to the head and neck. History of total nasal reconstruction with particular emphasis on the folded forehead flap technique. Even today pedicled forehead flap is referred to as the indian flap. Jul 01, 2004 skin flaps were first described by the indian physician sushruta in the samitha, written in approximately 500 bc, to replace noses amputated as punishment for theft and adultery. A 10year experience in nasal reconstruction with the.
Forehead flap reconstruction guys and st thomas nhs. Throughout history the technique has been modified and adjusted by many different surgeons and it has evolved to become a popular way of repairing nasal defects. By thinning the flap all at once after underlying lining and cartilage support has been created, the threestage forehead flap allows better aesthetic outcomes than twostage procedures for complex nasal reconstruction, says frederick j. Current developments in the use of 2staged paramedian forehead flap reconstruction are examined and a modern technique is presented. Plastic surgeon delves into history to reconstruct nose at gt hospital. This is the final of three live surgical videos to demonstrate the forehead flap used to repair a distal nasal tip defect.
Confined largely to the indian subcontinent for centuries, the forehead flap was subsequently adopted in europe by the italian antonio beanca in the 15th century. The vascular pedicle supports a cutaneous paddle, which is often optimal in terms of skin color matching, texture, and. The paramedian forehead flap for nasal reconstruction. The forehead flap has been used for many centuries and remains a workhorse flap for major nasal resurfacing. Patient underwent wide excision of the lesion with a margin of 2 cm and reconstruction of the resultant defect with forehead rotational flap fig.
Aggressive thinning of forehead flap to subcutaneous pl. Later texts, such as bretts surgical textbook published in calcutta in 1840, also described the median forehead flap technique for total rhinoplasty, reaffirming the common practice of total nasal reconstruction by a tribe of koomhars and potters living in the hills of suttledge, long famed for their dexterity in executing this operation. A little more history antonio branca 15 th century italy 18 th century uk j. Novak, in flaps and reconstructive surgery, 2009 supratrochlear artery. Regional flaps move excess tissue from facial areas adjacent to the nose the nasolabial fold the loose skin just lateral to the lip and nose in the smile line or from the forehead. Use of midforehead flap in nasal reconstruction scielo.
Alfords expertise performing many reconstructive surgeries. This video is intended to help others who may be going through similar pro. In all these cases he used the median 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. In the threestage forehead flap techniques, menick uses an intermediate operation. Forehead flap repair developed on an alternate pathway, being transmitted via an oral tradition, typically within families of craftsmen, at least as early as the 14th century. Their textbook, which was published in 1994, became the gold standard for. Covers the basic concepts of flap physiology, design, and mechanics of flap transfer, including multiple clinical examples for each flap. The forehead flap for nasal reconstruction dermatology. Alford has special interest and expertise with forehead flap reconstruction. The edcpf flap is a robust flap with a dual arterial supply and both rotation and advancement components. Three stage forehead folded flap for full thickness defects.
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