Forehead Reconstruction with Microvascular Flaps: Utility of Aesthetic Subunits

Abstract

Background Current literature describes the forehead as one aesthetic subunit of the face. We argue for the usefulness of aesthetic forehead subunits when microvascular flap reconstruction is required. Key to utilization of microvascular flaps for restoration of forehead subunits is an understanding of the patient population and defect characteristics most amiable to treatment.

Methods We conducted an International Review Board–approved retrospective chart review of nine consecutive patients who had undergone free flap reconstruction for large forehead defects.

Results The patients' foreheads included one paramedian defect; one central and paramedian defect; four central, paramedian, and lateral defects; and three lateral defects. Seven patients had ulnar forearm flaps and two had anterolateral thigh flaps. The success rate was 100%.

Conclusion A forehead subunit classification system has been devised that provides a suitable option for cases that benefit from distant tissue replacement in a single stage, while preserving the principles of aesthetic replacement.

Keywords

forehead aesthetic subunit - forehead microvascular flap - paramedian - central - lateral forehead subunits

• References

• 1 Hicks DL, Watson D. Soft tissue reconstruction of the forehead and temple. Facial Plast Surg Clin North Am 2005; 13: 243-251
• 2 Temple CL, Ross DC. Scalp and forehead reconstruction. Clin Plast Surg 2005; 32: 377-390 , vi–vii
• 3 Ahmed S, Hussein SS, Philp B, Healy C. Use of biologic dressing as a temporary wound dressing in reconstruction of a significant forehead Mohs defect. Dermatol Surg 2006; 32: 765-767
• 4 Naumann IC, Cordes SR. Giant basal cell carcinoma of the forehead with extensive intracranial involvement. Ann Otol Rhinol Laryngol 2007; 116: 663-666
• 5 Rocha LS, Paiva GR, de Oliveira LC, Filho JV, Santos ID, Andrews JM. Frontal reconstruction with frontal musculocutaneous V-Y island flap. Plast Reconstr Surg 2007; 120: 631-637
• 6 Redondo P. Geometric reconstructive surgery of the temple and lateral forehead: the best election for avoiding a graft. Dermatol Surg 2008; 34: 1553-1560
• 7 Desai RS, Donnelly HB. Repair of a glabellar and inferior forehead defect. Dermatol Surg 2006; 32: 112-114
• 8 Grigg R. Forehead and temple reconstruction. Otolaryngol Clin North Am 2001; 34: 583-600
• 9 Kruse-Lösler B, Presser D, Meyer U, Schul C, Luger T, Joos U. Reconstruction of large defects on the scalp and forehead as an interdisciplinary challenge: experience in the management of 39 cases. Eur J Surg Oncol 2006; 32: 1006-1014
• 10 Redondo P. Repair of large defects in the forehead using a median forehead rotation flap and advancement lateral U-shaped flap. Dermatol Surg 2006; 32: 843-846
• 11 Birgfeld CB, Chang B. The periglabellar flap for closure of central forehead defects. Plast Reconstr Surg 2007; 120: 130-133
• 12 Wang SQ, Goldberg LH. Burow's wedge advancement flap for lateral forehead defects. Dermatol Surg 2006; 32: 1505-1508
• 13 Weinzweig N, Davies B, Polley JW. Microsurgical forehead reconstruction: an aesthetic approach. Plast Reconstr Surg 1995; 95: 647-651
• 14 Radonich MA, Bisaccia E, Scarborough D. Management of large surgical defects of the forehead and scalp by imbrication of deep tissues. Dermatol Surg 2002; 28: 524-526
• 15 Neligan PC, Mulholland S, Irish J , et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg 1996; 98: 1159-1166 ; discussion 1167–1168
• 16 Rodriguez ED, Mithani SK, Bluebond-Langner R, Manson PN. Hand evaluation following ulnar forearm perforator flap harvest: a prospective study. Plast Reconstr Surg 2007; 120: 1598-1601
• 17 Rodriguez ED, Martin M, Bluebond-Langner R, Khalifeh M, Singh N, Manson PN. Microsurgical reconstruction of posttraumatic high-energy maxillary defects: establishing the effectiveness of early reconstruction. Plast Reconstr Surg 2007; 120 (7, Suppl 2) 103S-117S
• 18 Seline PC, Siegle RJ. Forehead reconstruction. Dermatol Clin 2005; 23: 1-11 , v
• 19 Hassanpour E, Mafi P, Mozafari N. Reconstruction of major forehead soft tissue defects with adjacent tissue and minimal scar formation. J Craniofac Surg 2005; 16: 1126-1130
• 20 Di Giuseppe A, Di Benedetto G, Stanizzi A, Pierangeli M, Bertani A. Skin expansion versus free forearm flap in forehead reconstruction. Microsurgery 1996; 17: 248-253
• 21 Chang SH, Tung KY, Hsiao HT. One-stage reconstruction of large scalp defect assisted with endoscopic forehead lifting and miniscrew external fixation techniques. Plast Reconstr Surg 2007; 119: 1382-1383
• 22 Amin A, Rifaat M, Civantos F, Weed D, Abu-Sedira M, Bassiouny M. Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg 2006; 22: 97-104
• 23 Antonopoulos D, Tsiliboti D, Skarpetas D, Masmanidis A. Complete orbit and forehead reconstruction using a free latissimus dorsi flap and MEDPOR implants. Head Neck 2006; 28: 559-563
• 24 Gonzalez-Ulloa M. Restoration of the face covering by means of selected skin in regional aesthetic units. Br J Plast Surg 1956; 9: 212-221
• 25 Deutsch BD, Becker FF. Secondary healing of Mohs defects of the forehead, temple, and lower eyelid. Arch Otolaryngol Head Neck Surg 1997; 123: 529-534
• 26 Rose EH. Aesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy. Plast Reconstr Surg 1995; 96: 1573-1585 ; discussion 1586–1587
• 27 Sakurai H, Takeuchi M, Fujiwara O , et al. Total face reconstruction with one expanded free flap. Surg Technol Int 2005; 14: 329-333
• 28 Warpeha RL. Resurfacing the burned face. Clin Plast Surg 1981; 8: 255-267
• 29 Dimitropoulos V, Bichakjian CK, Johnson TM. Forehead donor site full-thickness skin graft. Dermatol Surg 2005; 31: 324-326
• 30 Yassin O. New flap for restoration of the temporal hair line. Aesthetic Plast Surg 2007; 31: 596-598
• 31 Hoffmann JF. Tissue expansion in the head and neck. Facial Plast Surg Clin North Am 2005; 13: 315-324 , vii
• 32 Zaal LH, van der Horst CM. Results of the early use of tissue expansion for giant congenital melanocytic naevi on the scalp and face. J Plast Reconstr Aesthet Surg 2009; 62: 216-220
• 33 Mellette JR, Ho DQ. Interpolation flaps. Dermatol Clin 2005; 23: 87-112 , vi
• 34 Lutz BS. Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor-related scalp defects. Microsurgery 2002; 22: 258-264
• 35 McCombe D, Donato R, Hofer SO, Morrison W. Free flaps in the treatment of locally advanced malignancy of the scalp and forehead. Ann Plast Surg 2002; 48: 600-606
• 36 Lannon DA, Novak CB, Neligan PC. Resurfacing of colour-mismatched free flaps on the face with split-thickness skin grafts from the scalp. J Plast Reconstr Aesthet Surg 2009; 62: 1363-1366