This procedure requires an additional donor site for the skin graft and subsequent surgery. Patient demographics and defect size are in listed in the Table. of previous surgery or radiation adds to the difficulty of reconstruction. on each other which safeguards the possibility of orocutenous fistula in case there is dehiscence of A 41-years old male presented with 12 cm × 10 cm large fungating mass involving the left lower Forehead Flap: A Reliable Flap in operative time is much less and intensive post operative monitoring is cm x 8 cm to fill the mucosal defect. Patients and Methods: Two cases of oral carcinoma were resected and the defects were reconstructed The aim of Prakash BV, Mohammed Zuhaib, Hemanth Nagavarma. Lee S, Thiele C. Factors Associated With Free Flap Complications After Head and Neck Reconstruction and the Molecular Basis of Fibrotic Tissue Rearrangement in Preirradiated Soft Tissue. Supit L, Sudjatmiko G. The Extended Lateral Forehead Flap: Today as was 50-years ago. In such cases regional flaps may present a reasonable option. PMMC flap was raised in standard fashion with skin paddle of 7 The final incisions are closed with running 6-0 nylon. All these vessels are lined vertically and permit safe and effective transfer of the forehead flap on multiple individual vascular pedicles. Plast Aesthetic Res. We reiterate the usefulness of the lateral Bony fixation was done with plate and screws. 4.3A ) . All rights reserved, USA and worldwide. If this is not adequate, the incision can be extended or a contralateral flap can be created. The defect was reconstructed with a paramedian forehead flap and bilateral cheek advancement flaps. and inclusion of zygomatic branch further improves vascularity of the flap [4]. 2009;36(3):443–59. Versatility of Bi- Paddle PMMC Flap in Reconstruction of Oral Facial Defects. PMMC with rib has been documented for complex defects not required. In our cases we have used lateral forehead and PMMC flap to involving mandibular reconstruction. The colour match is also better with these flaps. Numerous articles1,2,5 on forehead flap techniques have barely one sentence dedicated to the donor site. Case Presentation: We present a case of a 76-year-old man with neglected giant BCC of nose extending to right lower eyelid and upper lip. Four patients required unilateral forehead rotational flaps for closure, and one required bilateral flaps. The mean age of the patients was 76 years (age range, 56-84 years). Patient age and sex, defect size and location, operative reports, follow-up, and complications were evaluated. Both of these flaps are robust which makes The lateral forehead flap is based on the anterior division of STA . If possible, the contralateral side should be spared in the event that a contralateral paramedian forehead flap becomes necessary. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in patients with previous history of radiation and surgery. swallowing comfortably (Figure 2) Clin Surg. Farwell DG, Futran ND. It does become supple with All flaps survived and This flap has been used for reconstruction of lower face for long. History Flap detachment Secotor 51, Gurgaon, 122001, India. 2014;66(4):414–7. This flap produces an excellent tissue color and texture match for nasal reconstruction. harvested with PMMC flap for reconstruction of the mandibular defect. The significance of the central artery and vein favours the median forehead flap as anatomically superior and the prominent central vein is a constant landmark on which to select the side of the pedicle. The junction of forehead and hair bearing To reduce the cosmetic impact we One benefit of letting the donor site heal secondarily is that it permits wound contraction. The donor defect was covered with split skin graft. 2017; 2: 1713. D, Profile view of the patient 13 months after the reconstruction. An epidermal turn-in flap from the lateral nasal subunit was used to reconstruct the intranasal lining . defects. Enter your email address below and we will send you the reset instructions. skin graft over the forehead. functional outcome was satisfactory. Sometimes these cases have been previously operated or irradiated which adds using the lateral forehead flap with the pectoralis myocutenous flap. Citation: Avinash A, Manik S, Vipul N. Lateral Forehead Flap: A Reliable Flap in Difficult Conditions. Nasal defect size ranged from 2 × 2 cm to 7 × 3 cm before subunit excision. the final outcome dependable. Cite this article as: Avinash A, Manik S, Vipul N. Lateral Shunyu NB, Medhi J, Laskar HA, Lyngdoh N, Syiemlieh J, Goyal A. superimposing on each other. Kazanjian advanced the development of the forehead flap by advocating primary closure of the forehead donor site. In patients with recurrent oral cancer In addition, by recruiting tissue laterally one minimizes the chance of distortion or lifting of the eyebrow, an oft-forgotten free margin. and insetting is done after a gap of 3-4 weeks depending on the size of Clin Surg. was less and the flap involved previously irradiated and scarred. situations. vascular anastomosis. Interpolated forehead and melolabial flaps. of locoregional flaps, alone or in combination may prove to be the only practical solution in certain This provides a safeguard against development of orocutenous fistula in case one of the flaps suffers variations of this flap have been described to reconstruct different part of ipsilateral face [7]. One patient had a trichial incision and required scar revision for alopecia. and inclusion of zygomatic branch further improves vascularity of B, Intraoperative photograph after bilateral cheek advancement flaps, paramedian forehead flap, and lateral forehead rotation flap for donor site closure. Jewett3 discusses donor site management and closure and advocates for placement of an acellular dermal matrix over the periosteum and then a staged full-thickness skin graft once the area has fully granulated. The extended lateral forehad flap (ELFF) was first introduced by Ian McGregor in 1963 to reconstruct an intraoral defect, he called it the temporal flap. Clear landmarks for defining the pedicle base for the median forehead flap are provided. The subunit principle in nasal reconstruction. This study reviews our experiences using lateral forehead rotational flaps to help close primarily large forehead flap donor sites. approach in similar cases. Aesthetic outcome of the donor defect was also acceptable. PMMC flap with However, for larger nasal defects, the donor site at the cephalic portion of the forehead is frequently too large to be closed primarily.5 Historically, these donor sites have been left to heal secondarily. It is unlikely that this would be aesthetically pleasing. The incision is placed pretrichially and extended to the temporal region. Many We present two such The pedicle is the anatomic part that resembles the stem of the flap. lowers the overall risk. Calvarial bone recreated the lateral nasal sidewall and was fixed with 3 plates . Gillies and Millard each modified and utilized the flap for patching various facial and intraoral defects and published their experience a year later. previous history of radiation [3]. He was eating and Other methods of skin cover include: expanded forehead flap, Gull-Winged flap, Tagliacozzi flap, and the Radial forearm free flap. These flaps are based on reliable vascular supply which rib was raised in standard fashion with skin paddle of 4 cm × 6 cm and 5 cm segment of the 5th rib. patients where have very limited options. Paramedian forehead flap—Supratrochlear artery location 1.5 cm lateral from midline at the medial eyebrow, marked by a lateral glabellar crease. 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. The relative inelasticity of flap is another feature of the forehead Published: 02 Nov, 2017 Microsurgical tissue transfer is considered the first options 2010;68(9):2169–78. The paramedian forehead flap is commonly used for nasal reconstruction.1-4 The donor site can typically be closed primarily with acceptable scarring.

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