A Strategy for Integrative Reconstruction of Midface Defects Using an Extended Forehead Flap

Abstract

Background: Midface reconstruction is challenging because the structures and deformities involved are complicated. In this study, we present a strategy for integrally reconstructing nasal and midface defects, including hair-bearing defects, using extended forehead-expanded flaps. Methods: From 2015 to 2018, a total of 22 patients with midface defects underwent reconstruction with extended forehead-expanded flaps. The far end of the expanded flap, which included scalp hair, was used to cover the upper lip defect (Type 1). In cases with large perioral defects (Type 2), we designed two separate supratrochlear artery flaps, one with a shorter pedicle for nasal reconstruction and the other with a longer pedicle for partial reconstruction. The pedicle of the longer flap was saved for upper lip recovery after pedicle interruption. Results: Among the 22 patients (13 male and 9 female), 17 were caused by burns and 5 by trauma. Nineteen patients had Type 1 defects, and three had Type 2 defects. The average postoperative follow-up was 17.6 -4.3 months. Patient satisfaction was excellent in most patients. Conclusions: Our extended forehead flap strategy can achieve aesthetic recovery of nasal and perioral defects with a single expansion treatment. The expanded flap can be flexibly designed to fit diverse midface defects.

Multistage Ala Nasi Repair with an Expanded and Prelaminated Forehead Flap: A Case Report

“…1 Tissue expansion of the forehead skin entails the use of forehead flaps for larger skin defects and the opportunity for direct suturing and thus improved donor site appearance and morbidity. Although the forehead flap is a well-known flap for nasal reconstruction after trauma, facial burns, and cancer, 2,4–6 we believe our technique is unique in that it provides the patient with a delicate appearance, whereas a prelaminated forehead flap usually results in a bulky appearance. 7 To ensure the delicate appearance, we placed the cartilage graft just underneath the dermis and refilled the expander to further press the graft up against the dermis to gain definition to the border of the reconstructed ala for a more natural looking facial unit.…”

Tracing the change and the contribution of subcutaneous adipose to skin expansion using a luciferase-transgenic fat transplantation model

“…2 Because regenerated skin has normal texture, structure, and appendages, it has been largely used for skin defect recovery. [3][4][5][6] Background: During skin expansion, subcutaneous adipose tissue undergoes the greatest change. The adipose layer appears to gradually thin or even disappear in long-term expansion.…”

“…2 Because regenerated skin has normal texture, structure, and appendages, it has been largely used for skin defect recovery. 3–6 However, there are many unknown mechanisms of tissue change during expansion. One of the most changed structures is the subcutaneous adipose layer.…”