Paramedian Forehead Flap

Abstract

The nose occupies a central location in the face, thus maintaining a principal factor in facial aesthetics. Any distortion would have major adverse repercussions on facial beauty. This has led to a near obsession in nasal reconstructive surgery preoccupying surgeons for many centuries. A variety of techniques have been described to reconstruct the nose. A deep understanding of nasal and facial anatomy is a prerequisite for both a successful and aesthetically pleasing outcome. A suitable harvest site would match the native nose in both texture and color, and have adequate tissue to reconstruct from partial subunits up to an entire nose. Additionally, adequate vascularity to survive transpositioning and sculpting is essential. Forehead flaps are two- to three-staged local musculocutaneous flaps based on a predictable pedicle with a distal random pattern of vascularity that meets the aforementioned criteria. Here we specifically discuss the paramedian forehead flap. This is centered over a single supratrochlear artery allowing the pedicle increased arc of rotation and adequate length. Main drawbacks being a vertical forehead scar, multiple stages, and the risk of necrosis if excessive distal flap thinning is undertaken at the outset in high-risk patients. Indications, preoperative markings, intraoperative steps, postoperative care, and a template of an operative dictation are included.