Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap.@*METHODS@#A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer.@*RESULTS@#Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes.@*CONCLUSION@#Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Versatility of Forehead Flap in Maxillofacial/Nasal and Intraoral Defects: A Retrospective Analysis

Introduction: Difficulties to find the ideal donor site with perfect matching tissues have always made the reconstruction of facial complex defect a tough problem for surgeons. The main aim of reconstruction is to restore facial contour (esthetics) and function (mastication, deglutition, and speech). Aim: The aim of the study was to analyze the versatility of forehead flap in maxillofacial/nasal and intraoral defects. Materials and Methods: This retrospective study was conducted to analyze the versatility of forehead flap in maxillofacial/nasal and intraoral defects. A total of 25 consecutive patients, of either sex, who required soft tissue reconstruction of the maxillofacial region, including oral cavity and nasal defects due to tumor ablative surgery. Follow-up was done for up to 4 months – 1 year and on every follow-up visit, patients were questioned about the degree of satisfaction, with mouth opening, swallowing, and donor site esthetics. Cosmetic deformity judged subjectively. Results: Of 25 patients, 17 patients were males, 12 patients were above 60 years. Maximum number of site of tumor involvement was noted in cheek 9 patients (36%) and in lower lip 5 patients (20%). About 44% patient had stage 2 tumors and 28% had stage 3 tumors. About 18 patient had adjuvant radiation, 1 patients had chemo RT, and 6 patients had no adjuvant treatment. About 16% of patients had a complication of altered forehead sensation. Conclusion: Forehead flap is a reliable technique for the reconstruction of maxillofacial region defects. It is easy to rise and can provide coverage for wide defects as far as the para mandibular and submandibular regions. Moreover, it does not require patient repositioning.

Reconstrucción de defectos totales del ala nasal en pacientes oncológicos / Nasal Ala Reconstruction for Total Defects in Cancer Patients

Introducción: El ala nasal es un área de frecuente incidencia de tumores malignos. La exéresis de estos, deja graves secuelas con repercusión negativa en el paciente. Objetivo: Caracterizar la reconstrucción de defectos totales del ala nasal en pacientes oncológicos. Método: Se realizó un estudio descriptivo, observacional, longitudinal y prospectivo en el Instituto Nacional de Oncología y Radiobiología desde abril de 2014 hasta abril de 2017. La muestra quedó conformada por 32 pacientes que cumplieron los criterios de selección. Resultados: Los pacientes del sexo masculino representaron la mayoría en el estudio. El carcinoma basal fue el diagnóstico histológico más frecuente. La resección de tumores primarios que resultaron en defectos aislados del ala nasal fueron el principal motivo de reconstrucción. El mayor porcentaje de los casos se reconstruyó de forma inmediata. El colgajo frontal fue la técnica más empleada, el cual presentó los mejores resultados estéticos y funcionales. El injerto compuesto de piel presentó el mayor índice de complicaciones. Conclusiones: Con el colgajo frontal doblado sobre sí mismo sin injerto de cartílago, se lograron los mejores resultados estéticos y funcionales(AU)

Introduction: Ala nasi is an area of frequent incidence of malignant tumors, whose exeresis leaves serious sequels with negative impact on the patient. Objective: To characterize nasal ala reconstruction for total defects in cancer patients. Method: A descriptive, observational, longitudinal and prospective study was carried out at National Institute of Oncology and Radiobiology, from April 2014 to April 2017. The sample consisted of 32 patients who met the selection criteria. Results: The study majority was represented by male patients. Basal carcinoma was the most frequent histological diagnosis. Resection of primary tumors that resulted in isolated defects of the nasal ala were the main reason for reconstruction. The highest percentage of cases were reconstructed immediately. The forehead flap was the most used technique, and presented the best aesthetic and functional results. The composite skin graft presented the highest rate of complications. Conclusions: With the forehead flap folded on itself and without cartilage graft, the best aesthetic and functional results were achieved(AU)

Forehead skin expansion combine with auricular cartilage for repairing nose alar full-thickness defects / 中华医学美学美容杂志

Objective To discuss clinical curative effects of using Forehead skin expansion combine with auricular cartilage for repairing nose alar full-thickness defects.Methods From August 2010 to August 2010,36 patients with nose alar full-thickness defects in the second affiliated hospital of kunmin medical university,The defect range exceed 1.5 cm× 1.2 cm.50-80 ml expander was implanted in forehead and injected saline water to expand in order to acquire extra skin.We Turn around the skin of defect as the lining of nose,harvest ipsilateral auricular cartilage for nose ala framework,Expanded forehead pedicle flap was transferred to cover framework.The donor area was sutured directly.The pedicle of flap was cut and trimmed after 2 months.Results Follow-up time of 3-18 months after the operation,All flaps are survive,nose alar defects are repaired successfully.Some cases were performed second surgery,postoperative,nose alar color,thickness,nostril size and shape the same with the contralateral side.Donor site healed with linear scar.Conclusions This method could be easy to obtain excess skin,for repairing large sides nose alar full-thickness defect.Frontal scar is not obvious,It is a practical.

Giant Basal Cell Carcinoma Treated with a Paramedian Forehead Flap in a Patient with Leprosy / 대한피부과학회지

No abstract available.

Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report

Reconstructive rhinoplasty is one of the unique areas of rhinoplasty, but its concept and technique have not been widely established in Korea compared to cosmetic rhinoplasty. Nasal reconstruction poses a challenging problem when the defect is large and involves all 3 layers of the nose including the septum. We report a patient who underwent nasal reconstruction due to subtotal, full thickness defect of the nose after repeated failed rhinoplasties including use of a nasolabial flap. A staged operation was planned. First, a radial forearm free flap was used to reconstruct the inner layer. After 4 months, the bulk of the forearm tissue was reduced and used as inner lining at the second operation. In the second operation, the framework of the lower 2/3 of the nose was formed of autologous rib cartilage, and the outer skin defect was covered with a forehead flap. Six weeks later, the forehead flap was divided. One year after the last operation, the patient can breathe well, and his nose has better esthetics than before surgery. We believe this is the first report of nasal reconstruction using a radial forearm free flap and a forehead flap to restore a subtotal, full thickness defect of a nose.

Nursing cooperation of double pedicle of forehead flap for repair of mouth scar contracture deformity / 中国实用护理杂志

Objective To explore the points of nursing cooperation during double pedicle of forehead flap for repair of mouth scar contracture deformity.Methods The psychological nursing,equipment and instrument preparation,cooperation of instrument nurses and circuit nurses were summarized in 15 cases of an expanded forehead flap for repair of mouth scar contracture.Results The operation process was smooth,all the flaps survived,repair effect was good,no complications occurred.Conclusions Burn plastic surgery specialist nurses in operation room giving careful preoperative visit and nursing risk assessment can alleviate the psychological pressure of the patients,reduce the defects of nursing.Close cooperation during operation and effective environmental management is critical for successful completion of operation.

Simultaneous Upper and Lower Eyelid Reconstruction for Eyelid Defects Following a Dog Bite

PURPOSE: While the principles of eyelid reconstruction are well established, the rapid choice of a method of upper and lower eyelid defect reconstruction is difficult. The authors present a successful case of simultaneous reconstruction of upper and lower eyelid defects with a modified paramedian forehead flap resulting from a dog bite. CASE SUMMARY: The authors report a case of a 77-year-old woman with total hyphema and extensive skin defects involving the forehead, cheek, and upper and lower eyelid resulting from a dog bite. The wound on the left periorbital area was treated with microimplantation and skin grafts from the left thigh and groin. In the weeks following, sequential failure of the flap and skin graft was observed, and exposed keratitis worsened, resulting in corneal perforation. Evisceration with hydroxyapatite implantation and paramedian forehead flap was performed. After 3 weeks, division of the pedicle, transverse division of the flap, and socket reconstruction were performed. CONCLUSIONS: Reconstruction of large, full thickness defects of both upper and lower eyelids with a paramedian forehead flap is associated with a good cosmetic outcome. Paramedian forehead flap should be considered as an effective choice for simultaneous upper and lower eyelid reconstruction.

Reconstruction of Nasal Defects after Skin Cancer Excision by Paramedian Forehead Flap / 대한피부과학회지

BACKGROUND: Repairing large nasal defects in the nose gives us technical challenge. Despite the commonly available surgical techniques, paramedian forehead flap (PFF), an arterial flap, should be considered in repairing some of the large nasal defects. OBJECTIVE: The aim of this study was to evaluate the effectiveness and cosmetic consequences of PFF for the reconstruction of large nasal defects after skin cancer excision. METHODS: Between 2008 and 2011, 8 patients were treated with PFF for reconstruction of large nasal defects after Mohs surgery or wide excision. We reviewed surgical techniques, complications, and final results. Post-operative results were assessed with serial clinical photographs, physicians' objective records and patients' subjective records. RESULTS: The size of surgical defects was ranged from 2.0 to 3.0 cm in their greatest diameter, involving at least 2 cosmetic subunits after tumor excision. Frequent involved sites were nasal tip and nasal dorsum. There were no significant complications, except transient bleeding and oozing. The cosmetic outcomes were considered as good or excellent in most of patients. CONCLUSION: PFF is regarded as the recommended technique for the repair of large nasal defects, involving several cosmetic subunits, providing excellent cosmetic results with few complications.

Reconstruction of Nasal Defects after Skin Cancer Excision by Paramedian Forehead Flap / 대한피부과학회지

BACKGROUND: Repairing large nasal defects in the nose gives us technical challenge. Despite the commonly available surgical techniques, paramedian forehead flap (PFF), an arterial flap, should be considered in repairing some of the large nasal defects. OBJECTIVE: The aim of this study was to evaluate the effectiveness and cosmetic consequences of PFF for the reconstruction of large nasal defects after skin cancer excision. METHODS: Between 2008 and 2011, 8 patients were treated with PFF for reconstruction of large nasal defects after Mohs surgery or wide excision. We reviewed surgical techniques, complications, and final results. Post-operative results were assessed with serial clinical photographs, physicians' objective records and patients' subjective records. RESULTS: The size of surgical defects was ranged from 2.0 to 3.0 cm in their greatest diameter, involving at least 2 cosmetic subunits after tumor excision. Frequent involved sites were nasal tip and nasal dorsum. There were no significant complications, except transient bleeding and oozing. The cosmetic outcomes were considered as good or excellent in most of patients. CONCLUSION: PFF is regarded as the recommended technique for the repair of large nasal defects, involving several cosmetic subunits, providing excellent cosmetic results with few complications.

Optimal use of forehead flap pedicled with supratrochlear artery for aesthetic reconstruction of nose / 中华医学美学美容杂志

Objective To explore the design of forehead flap pedicled with supratrochlear artery and shift way for aesthetic reconstruction of the nose without secondary operations for debulking.Methods Origin of blood supplies and the distributed situation of the vessel in the frontal region were studied through the internal carotid artery and the external carotid artery X-ray angiography.The frontal region existed polyphyletic blood supplies,the supratrochlear artery and the supraorbital artery set out many branches,respectively,in the level of frontal bone eyebrow plane.One constant,thicker horizontal branch from the superficial temporal artery obviously extended to the forehead median.The branches from three blood vessels mentioned above constituted the network of artery adequate in the muscle and the subcutaneous tissue level,assumed the three-dimensional distribution in the forchead region.The nasal reconstruction had been done for 9 patients with the oblique orientation designed forehead flap by using one side of supratrochlear artery as the pedicle and cutting skin paddle with the same or the opposite side of forehead flap.Results All flap survived completely with the restoration of nasal shape and functional satisfaction.Conclusion The forehead oblique orientation flap pedicled with one side supratrochlear artery is nourished by the rich blood supply.The flap can be split into two flaps:a myofascial flap and a skin flap in far part.Myofascial flap may be the good package of cartilage framework,and simultaneously split skin flap is favorable of the shape models.The flap may satisfy the demand of the nasal restoration.

Upper Eyelid Reconstruction Using the Medpor(R) Sheet and Median Forehead Flap

PURPOSE: To report the upper eyelid reconstruction with median forehead flap and Medpor(R) sheet implant following full-thickness eyelid defect resulting from tumor resection. CASE SUMMARY: A 65-year-old woman was examined at our hospital for a recurrent mass on the right upper eyelid. A wide tumor excision with a 3 mm margin and an eyelid reconstruction procedure were performed after a frozen section biopsy revealed a malignancy. The full-thickness eyelid defect was reconstructed with a median forehead flap as a substitute for skin and muscle and a Medpor(R) sheet substituted for tarsal plate was sutured with a lower conjunctiva flap for posterior lamella. The histopathology diagnosis of the lesion showed a well-differentiated squamous cell carcinoma. The lower conjunctiva was separated at 2 weeks after surgery, and then the median forehead flap detached from the upper eyelid skin at 8 weeks after surgery. One year postoperatively, there was no evidence of a wound infection and an exposure of the Medpor(R) sheet. The eyelid had a good cosmetic contour and the movement of the eyelid during blinking was natural. CONCLUSIONS: The use of a Medpor(R) sheet as a substitute for a tarsal plate in reconstructive procedures of the upper eyelid defect shows cosmetic and functional success.

Improvement in nasal reconstruction with an expanded forehead flap from an aesthetical point of view / 中华医学美学美容杂志

Objective To investigate the operative methods and merits of nasal reconstruction in terms of the aesthetics. Methods The noses of 12 patients were reconstructed with an expanded triangle-shaped forehead flap with unilateral supratrochlear artery, a skin expander was placed obliquely under galea aponeurotica of forehead. Liquid was injected with conventional expansion method. Using the skin and the scars on nasal dorsum and tip as lining, based on intercanthal distance and aesthetic standard, a triangle-shaped forehead myocutaneous flap was designed over the expanded forehead skin tissue and used for a nasal reconstruction. The triangle-shaped flap was trimmed to different layer and reshaped based on aesthetic subunit.Results In twelve post-operative patients with nasal defect, no flap necrosis was found and the appearance of reconstructed noses were almost normal and satisfactory after follow-up for 6 months to 2 years. Conclusion The modified forehead myocutaneous flap according to aesthetic standard is safe and ideal for major nasal reconstruction. Meticulous moulding of triangle-shaped flap, nose interior with good blood supply, and primary insertion of nose stretcher are the key to a satisfactory appearance.

Repairing of defect around orbit with a forehead flap / 中华医学美学美容杂志

Objective To study the method of repairing the periorbit tissue defect using a forehead myocutaneous flap transplantation. Methods The retrospective investigation was performed in 6 cases of the periorbit tissue defect being repaired with the forehead flap with a pedicle of superficial temporal ves-sels and fascia during 2001 to 2007 by mierosurgieal techniques. The size of transplantatcd skin flap ranged from 2.5 cm×3.0 cm to 8 cm×5 cm. Results Six cases of forehead flap transplantation with a superficial temporal vessels and fascia pedicle were completely survival and achieved aesthetic contouring. Conclusion The method of forehead flap transplantation with a superficial temporal vessels and fascia pedicle is a safe and potent choice for the reconstruction of the periorbit tissue defect.

Color Analysis of Forehead Flap and Full Thickness Skin Graft in Facial Reconstruction

PURPOSE: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match. METHODS: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness). RESULTS: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins. CONCLUSION: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.

Nasal Reconstruction in the 21st Century: A Contemporary Review

Nasal restoration in the 21st century has reached a new milestone that has brought together centuries of experiences, lessons, errors, and rewards. The bar has been set and it is nothing less than a restoration of normal function and complete social acceptance. The aesthetic expectations of both minor and major nasal repair include symmetry, natural contour, excellent color and texture match, and a final product that remains inconspicuous to the casual observer. The major tenets that have been realized today include the wide application of the subunit principle, liberal and nonanatomic cartilage grafting (for form and function), and addressing each of the three layers of the nose independently. Anticipating resultant scars and vectors of tension during wound healing are the subtle nuances of nasal reconstruction that ensure a pleasing result. The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.

Nasal Reconstruction in the 21st Century: A Contemporary Review

Nasal restoration in the 21st century has reached a new milestone that has brought together centuries of experiences, lessons, errors, and rewards. The bar has been set and it is nothing less than a restoration of normal function and complete social acceptance. The aesthetic expectations of both minor and major nasal repair include symmetry, natural contour, excellent color and texture match, and a final product that remains inconspicuous to the casual observer. The major tenets that have been realized today include the wide application of the subunit principle, liberal and nonanatomic cartilage grafting (for form and function), and addressing each of the three layers of the nose independently. Anticipating resultant scars and vectors of tension during wound healing are the subtle nuances of nasal reconstruction that ensure a pleasing result. The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.

Temporalis muscle-coronoid swing and forehead skin island flap reconstruction of the orbit after maxillectomy

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction. Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction. Design: Surgical Innovation/ Case Report. Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy. Methods: The course of tumor excision and defect reconstruction is described. Results:There was no diplopia or other morbidity.There was minimal added operative time for reconstruction with acceptable results. Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery. (Author)

A case report of the external nose reconstruction using forehead flap and auricular composite grafts

There are various surgical methods for reconstruction of the nasal defect. Among them, there is some difference in the choosing the proper reconstruction method according to defect size and position. When the defect involved the tip, the columella, and the alar, the local flaps may be preferred, because they can provide sufficient amount of tissue. However, the composite grafts from the ear have been effectively used in reconstructions of smaller sized defects of the columella and ala. We excised total external nose because of squamous cell carcinoma on the nasal tip, columella, and nasal septum. We reconstructed the nasal tip, both alae, and columella with forehead flap. After division of the regional flap, we found partial necrosis of the columella and narrowness of the nostril. So, we used chondrocutaneous auricular composite grafts for reconstruction of the columella and both nostrils. We used the file-folder designed auricular composite graft for reconstruction of columella and the wedge shaped ear helical composite grafts for widening of nostrils. 6 months later, there were no significant problems, except some mismatched dark color in the grafted alar tissues. Here, we report a successful reconstruction of large nasal defect using combined two different reconstructive methods.

Nasal deformities and their treatments in the leprosy patients (I) / 나학회지

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.