The forehead flap: a valuable option in resource depleted environment

Abstract

Aim: Reconstruction of orofacial soft tissue defect is often challenging and this is more difficult in resource challenged environment. This retrospective study highlights our experience with the use of forehead flap to overcome some of the challenges of orofacial reconstruction in a resource depleted environment. Methods: A 23-year retrospective analysis of all patients who had orofacial defect reconstruction using forehead flap in our department was undertaken. Information was sourced from patient's case notes and operating theatre records. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results: A total of 43 patients were managed within the period reviewed and consisted of 31 (72.1%) males and 12 (27.9%) females. Trauma 24 (55.8%) accounted for most defect and the lip was the commonest site of defect. Complete forehead flap was used in 31 (72.1%) of cases and when timing of defect repair is considered, delayed reconstruction was the preferred method. Postoperative complications was observed in 8 (18.6%) patients and consisted of failed flap in 2 (25.0%) patients, tumor recurrence in reconstructed site in 2 (25.0%) patients and tumor occurrence in forehead flap donor site in 1 (12.5%) patient. Conclusion: The forehead flap remains a reliable option in orofacial soft tissue defect reconstruction. It is easy to raise and can provide coverage for wide defects as far as the paramandibular and submandibular regions. Moreover, it does not require patient repositioning.

Forehead flap: a reconstructive option in selected complex defects following resection of oral cancers staged T4

“…15,16 10 of our patients underwent folded forehead flap for defects which also involved the oral commissure and lower lip as popularised in different studies. 14,17 Jatin Shah introduced the use of folded forehead flap as a two stage reconstruction for full thickness cheek defects, in contrast all patients in our series underwent a single stage reconstruction using folded forehead flap as described in the literature. 14,18 Like the series from Pakistan all our forehead flaps which were tunnelled into the oral defect were routed deep to the zygomatic arch, in our series 10 flaps were rotated externally into the defect and in 8 patients the externally rotated flaps were lined on the inner aspect with split skin graft.…”

A Large Squamous Cell Carcinoma on the Face Treated with Wide Excision and Defect Closure Using Forehead Flap Reconstruction

“…9,10 To prevent improper determination of surgical margin, intraoperative frozen section has been used to establish the tumor-free margin. 11 Reconstruction for postoperative defects by flaps and/or skin grafts in SCC might be challenging due to its functional and aesthetical reasons. 11,12 A skin flap is performed to close surgical wounds that interfere with the patient's functioning and aesthetical aspects, while skin grafts can be performed for defects that cannot be appropriately closed by a skin flap.…”

“…11 Reconstruction for postoperative defects by flaps and/or skin grafts in SCC might be challenging due to its functional and aesthetical reasons. 11,12 A skin flap is performed to close surgical wounds that interfere with the patient's functioning and aesthetical aspects, while skin grafts can be performed for defects that cannot be appropriately closed by a skin flap. 13 This case reports aims to elaborate an SCC management on the cheek by wide excision and intraoperative frozen section, while closure of the defect was done using a forehead interpolation flap reconstruction combined with a skin graft.…”

“…Flap donors taken from the forehead skin are suitable for reconstructing defects in the cheek, oral cavity, maxillary antrum, and mouth corners due to their similarity in texture and color, along with appropriate vascularization on the recipient tissue. 11,19 As for the donor site on the forehead, the wound was extensive so that primary closure would not be appropriate. Therefore, FTSG for wound closure on the forehead was performed.…”

“…Choosing a skin donor and grafting technique depend on the vascularity, contour, texture, and recipient area. 11,25 The use of the abdominal skin as a donor has its benefit as it may provide a large coverage, tension-free results at the site of the defect, and cosmetically symmetrical result, therefore it is preferred by patients. 25 Overall, the patient in this case report responded very well upon observation.…”