Forehead Flaps Workup

  • Author: Stephen S Park, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jul 22, 2011
 

Laboratory Studies

  • Laboratory testing follows standard preoperative evaluation and screening.
  • A history of clotting problems or easy bruising indicates that hematological studies or bleeding times may help identify potential surgical risks.
  • If general anesthesia is used, other testing, such as ECG, chest radiographs, and chemistry panels, may be indicated depending on a patient's particular health status and anesthetic risk.
  • Other preoperative preparations include various methods of optimizing surgical outcome depending on specific medical history.
    • Maximize the nutritional status of malnourished patients.
    • Serum albumin levels less than 3 g/dL impair healing.
    • If a patient's skin has excessive comedones, a brief presurgical course with tretinoin may reduce severity.
    • Dermabrasion may be used to minimize the degree of rhinophyma and improve recipient site contour.
    • Patients with diabetes should have tight glucose control to improve healing.
    • Patients who use tobacco products may be counseled at this time about the significant deleterious effects of nicotine, including compromised flap viability.
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Imaging Studies

  • No specific radiographic imaging studies are required.
  • Preoperative photography is essential to document the defect, allow outcome review and comparison, and educate the patient regarding the condition prior to surgery.
  • Confirmation of the supratrochlear artery location and its path up the forehead can be achieved using Doppler studies, angiography, or palpation. These are not typically necessary because the anatomy in this region is consistent.
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Contributor Information and Disclosures
Author

Stephen S Park, MD  Professor and Vice-Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of Virginia Medical Center/Cosmetic Surgery Center

Stephen S Park, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, and Virginia Society of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel G Becker, MD  Clinical Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastics and Reconstructive Surgery, University of Pennsylvania

Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  6. Calhoun KH, Tan LKS. Skin cancer. In: Gates GA, ed. Current Therapies in Otolaryngology-Head and Neck Surgery. 6th ed. St. Louis, Mo: Mosby; 1998.

  7. Carpue JC. An account of two successful operations for restoring a lost nose. Plast Reconstr Surg. Aug 1969;44(2):175-82. [Medline].

  8. Cook TA, Park SS. Locoregional flaps for facial resurfacing. In: Myers EN, ed. Advances in Otolaryngology-Head and Neck Surgery. St. Louis, Mo: Mosby; 1995:. 1-28.

  9. Kleintjes WG. Forehead anatomy: arterial variations and venous link of the midline forehead flap. J Plast Reconstr Aesthet Surg. 2007;60(6):593-606. [Medline].

  10. Mazzola RF, Marcus S. History of total nasal reconstruction with particular emphasis on the folded forehead flap technique. Plast Reconstr Surg. Sep 1983;72(3):408-14. [Medline].

  11. Oo KK, Park SS. The midline forehead flap in nasal reconstruction. Facial Plast Surg Clin North Am. Feb 2011;19(1):141-55. [Medline].

  12. Park SS. Cutaneous lesions and local flaps. In Park SS, ed. Facial Plastic Surgery â€" an Essential Guide. New York, NY: Thieme; 2005.

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  16. Quatela VC, Sherris DA, Rounds MF. Esthetic refinements in forehead flap nasal reconstruction. Arch Otolaryngol Head Neck Surg. Oct 1995;121(10):1106-13. [Medline].

  17. Samhita S. English translation of the Sushruta Samhita based on original Sanskrit text. Bose, Calcutta, India: Kaviraj Kunja Lal Bhishagratna; 1907-1916.

  18. Shumrick KA, Campbell A. Improvements in forehead flap design for nasal reconstruction. Facial Plast Surg. 1998;14(2):165-71. [Medline].

  19. Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg. Apr 1992;118(4):373-9. [Medline].

  20. Stephen S. Park, MD. Cutaneous Lesions and Facial Reconstruction. In: Facial Plastic Surgery: the Essential Guide. New York: Thieme; 2005:61 - 115.

  21. Tardy ME Jr, Sykes J, Kron T. The precise midline forehead flap in reconstruction of the nose. Clin Plast Surg. Jul 1985;12(3):481-94. [Medline].

  22. Tardy ME, Brown RJ. Surgical Anatomy of the Nose. New York, NY: Raven Press; 1990:. 25.

  23. Thomas JR, Griner N, Cook TA. The precise midline forehead flap as a musculocutaneous flap. Arch Otolaryngol Head Neck Surg. Jan 1988;114(1):79-84. [Medline].

  24. Tollefson TT, Kriet JD. Comple nasal defects. In Park SS, ed. Facial Plastic Surgery Clinics of North America. Philadelphia, PA: Elsevier Inc; 2005..

  25. Woodard CR, Park SS. Reconstruction of nasal defects 1.5 cm or smaller. Arch Facial Plast Surg. Mar-Apr 2011;13(2):97-102. [Medline].

 
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A is a median forehead flap over the forehead vasculature. B is the paramedian forehead flap over the forehead vasculature. C is the midline forehead flap over the forehead vasculature.
The anatomic relationship of the supratrochlear vessels and the periorbital and forehead musculature.
Aesthetic subunits of the nose.
Photograph on left depicts a nasal defect following Mohs surgery. Center photograph shows the defect defined in terms of subunits involving the ala, nasal tip, and cheek. Photograph on right shows the completion of the aesthetic subunits and advancement of the cheek flap up to the nasal facial sulcus.
A is a nasal defect template (from suture package). B is the template transferred to the precise midline of the forehead.
A is a flap elevation in the subcutaneous plan, superficial to the frontalis muscle. B is a selective thinning to best match normal nasal skin thickness.
Periosteum incorporated into the pedicle base.
Midline forehead flap transferred to the nose.
The left photograph is the planned pedicle division. The right photograph is the pedicle stump partially inset into the glabella.
The left photograph shows a 2-year postoperative frontal view. The right photograph is an oblique view of the same patient.
Large nasal defect following excision of skin malignancy.
Frontal postoperative view.
Aesthetic units drawn.
Midline forehead flap outlined.
Close oblique postoperative view.
 
 
 
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