The Importance of Expanded Forehead Flap in Nasal Reconstruction | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 5, Volume 44, Issue 2, April 2020, Pages 263-273 PDF (48.06 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2020.112462 | ||
| Authors | ||
| Karima T. Ismail* ; Mariam T. Ismail; Ahmed T. Ismail | ||
| The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University | ||
| 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 | ||
| Forehead; Flap; Nasal reconstruction | ||
| References | ||
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Burget G.C. and Menick F.J.: Nasal support and lining: The marriage of beauty and blood supply. Plast. Reconstr. Srug 81: 189, 1989. 2- Millard D.R., Jr.: Aesthetic reconstructive rhinoplasty. Clin. Plast. Surg., 8: 169, 1981. 3- Burget G.C. and Menick F.G.: The subunit principle in nasal reconstruction. Plast. Reconstr. Surg., 76: 239, 1985. 4- Elliot R.: Rotation flaps of the nose. Plast. Reconstr. Surg., 44; 147: 1969. 5- Mc Gregor J.C. and Soutar D.S.: A critical assessment of the bilobed flap. BRJ Plast. Surg., 34; 197: 1981. 6- Marchac D. and Toth B.: The axial frontonasal flap revisited. Plast. Reconstr. Surg., 76: 686, 1985. 7- Herbert D.C.: A subecutaneons pedicle cheek flap for reconstruction of ala defects. BRJ Plast. Surg., 31; 79: 1978. 8- Menick F.G.: The aesthetic use of the forehead for nasal reconstruction the paramedian forehead flaps. In: Tobin G, ed. Clinics in Plastic surgery. Hiladelphia WB Saurders, 670, 1990. 9- Menick F.J.: A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast. Reconstr. Surg., 109: 1839, 2002 10- Siegert R., Weerda H., Hoffmann S. and Mohadjer C.: Clinical and experimental evaluation of intermittent intraoperative short term. Expansion. Europ. Arch. Otorhino- laryngol., 249; 119, 1992. 11- McDowell F.: The Source Book of Plastic Surgery. Baltimore: Waverly Press, 1977. 12- Gillies H.D. and Millard R.: The principles and Art of Plastic surgery. Boston: Little, Bran, 1957. 13- Sam Naficy: Structural support. In shan R. Baker, Sam Naficy, Principles of Nasal Reconstruction. St. Louis, Mosby, 2002. 14- Weerda H.: Reconstructive Facial Plastic Surgery, Stuttgart, Geiorg. Theime Verlag, 2003. 15- Menick F.J.: Nasal Reconstruction: Forehead flap. Plast. Reconstr. Surg., 113: 100, 2004. Egypt, J. Plast. Reconstr. Surg., April 2020 273 16- Burget G.C.: Aesthetic restoration of the nose. Clin. Plast. Surg., 12: 463, 1985. 17- Menick F.G.: The aesthetic use of the forehead for nasal reconstruction the paramedian forehead flaps. In: Tobin G., ed. Clinics in Plastic surgery. Hiladelphia WB Saurders, 670, 1990. 18- Burget G.C. and Menick F.J.: Nasal reconstruction: Seeking a fourth dimension. Plast. Reconstr. Surg., 78: 145, 1986. 19- Breasted J.H.: Edwin Smith Surgical Papyrus. In Facsimile and Hieroglyphic Transliteration with Translation and Commentary. Chicago: University of Chicago Press, 1930. | ||
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