Complete division of the pedicle of the forehead flap is possible after 1 week of engraftment in selected patients

Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.

[Nasal reconstruction with paramedian forehead flaps]

The nose has an important function in the esthetic perception of the face. The esthetic coverage of defects on the nose is therefore of particular importance; however, the position is exposed to sunlight and poses a particular risk for the development of non-melanoma skin cancer (NMSC) and melanomas. After tumor excision, the size of the defect is decisive for defect closure. In addition, multilayer defects in which the cartilage or mucous membranes must be reconstructed by plastic surgery, represent a particular challenge for the surgeon. There are various options for reconstruction depending on the extent of the defects on the nose. This article gives an overview of the paramedian forehead flap, the indications and implementation.