Reconstruction of large facial defects using a combination of forehead flap and other procedures

Abstract

Background: Reconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated.Methods: A total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients’ medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires.Results: Along with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high.Conclusion: Reconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.

Forehead Flap for Facial Defects Reconstruction: Case Series and Review of The Literature

“…4 Even for skilled plastic surgeons, reconstructing large facial deformities satisfactorily on both a cosmetic and functional level can be difficult since facial skin structure varies depending on creases, wrinkles, and skin thickness. 6 Forehead flaps provide an excellent supply because they are designed with an intact major blood vessel, and they don't require microsurgical expertise, therefore it's a reliable option especially for general plastic surgeons. 7 In case number 2, the defect was first reconstructed with a free flap but resulting in a free flap loss.…”

Modified Keystone Perforator Island Flap Techniques for Small- to Moderate-Sized Scalp and Forehead Defect Coverage: A Retrospective Observational Study

“…The tissue tautness caused by the convexity of the scalp and forehead frequently results in challenging defects that can be difficult to repair [ 1 , 2 , 3 , 4 ]. Primary closure is usually possible only for small scalp and forehead defects with a diameter of approximately 2–3 cm [ 1 , 5 ]. Diverse scalp and forehead reconstruction options have been developed, including skin grafting, dermal substitutes, tissue expander, locoregional flaps, and microvascular tissue transfer [ 1 , 2 , 3 , 4 ].…”

Palmar reconstruction using full-thickness skin grafts from the groin and lateral malleolus regions: A comparison of long-term outcomes

“…[ 3 , 4 ] Despite their effectiveness, skin grafts have several disadvantages including contracture, hyperpigmentation, erythema, color mismatch, decreased hair growth, and reduced durability. [ 4 , 5 ] Additionally, patients may be dissatisfied with skin grafts, particularly because of early hyperpigmentation and erythema, which can cause color differences between graft and donor sites. [ 3 ] To avoid dissatisfaction, the donor site should match the graft site in terms of color, adnexal quality, consistency, thickness, and texture.…”