Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Ryuck Seong (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Yi, Changryul (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Kim, Hoon Soo (Department of Dermatology, Pusan National University School of Medicine) ;
  • Jeong, Ho Yoon (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Bae, Yong Chan (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine)
  • Received : 2021.08.20
  • Accepted : 2021.12.16
  • Published : 2022.02.20
Download PDF
⟨ Previous Next ⟩

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.

Keywords

Acknowledgement

This work was supported by a clinical research grant from Pusan National University Hospital in 2021.

References

  1. Russo F, Linares M, Iglesias ME, Martinez-Amo JL, Cabo F, Tercedor J, et al. Reconstruction techniques of choice for the facial cosmetic units. Actas Dermosifiliogr 2017;108:729-37. https://doi.org/10.1016/j.ad.2017.02.017
  2. Lee KS, Kim JO, Kim NG, Lee YJ, Park YJ, Kim JS. A comparison of the local flap and skin graft by location of face in reconstruction after resection of facial skin cancer. Arch Craniofac Surg 2017;18:255-60. https://doi.org/10.7181/acfs.2017.18.4.255
  3. Menick FJ. Facial reconstruction with local and distant tissue: the interface of aesthetic and reconstructive surgery. Plast Reconstr Surg 1998;102:1424-33. https://doi.org/10.1097/00006534-199810000-00015
  4. Ji C, Li R, Shen G, Zhang J, Liang W. Multiple pedicled flaps cover for large defects following resection of malignant tumors with partition concept. Medicine (Baltimore) 2017;96:e7455. https://doi.org/10.1097/MD.0000000000007455
  5. Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg 2013;27:96-103. https://doi.org/10.1055/s-0033-1351231
  6. Menick FJ. Nasal reconstruction with a forehead flap. Clin Plast Surg 2009;36:443-59. https://doi.org/10.1016/j.cps.2009.02.015
  7. Choi JS, Bae YC, Nam SB, Bae SH, Kim GW. Evaluation of the donor site after the median forehead flap. Arch Plast Surg 2018;45:259-65. https://doi.org/10.5999/aps.2017.01277
  8. Burget GC, Walton RL. Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units. Plast Reconstr Surg 2007;120:1171-207. https://doi.org/10.1097/01.prs.0000254362.53706.91
  9. Chang JW, Lim JH, Lee JH. Reconstruction of midface defects using local flaps: an algorithm for appropriate flap choice. Medicine (Baltimore) 2019;98:e18021. https://doi.org/10.1097/MD.0000000000018021
  10. Lee YJ, Lee KT, Pyon JK. Finger reduction of nasal bone fracture under local anesthesia: outcomes and patient reported satisfaction. Arch Craniofac Surg 2019;20:24-30. https://doi.org/10.7181/acfs.2018.02222
  11. Pawar SS, Kim MM. Updates in forehead flap reconstruction of facial defects. Curr Opin Otolaryngol Head Neck Surg 2013;21:384-8. https://doi.org/10.1097/MOO.0b013e328362ce42
  12. Fan J. A new technique of scarless expanded forehead flap for reconstructive surgery. Plast Reconstr Surg 2000;106:777-85. https://doi.org/10.1097/00006534-200009040-00004
  13. Elshamma NA, Al Qabbani A, Alkatan HM, Al-Qattan MM. The use of forehead flaps in the management of large basal cell carcinomas of the medial canthus/medial lower eyelid in Saudi patients. Saudi J Ophthalmol 2013;27:223-5. https://doi.org/10.1016/j.sjopt.2013.07.005
  14. Lee DM, Bae YC, Nam SB, Bae SH, Choi JS. Reconstruction of large facial defects via excision of skin cancer using two or more regional flaps. Arch Plast Surg 2017;44:319-23. https://doi.org/10.5999/aps.2017.44.4.319
  15. Santos Stahl A, Gubisch W, Fischer H, Haack S, Meisner C, Stahl S. A cohort study of paramedian forehead flap in 2 stages (87 flaps) and 3 stages (100 flaps). Ann Plast Surg 2015;75:615-9. https://doi.org/10.1097/SAP.0000000000000209
  16. Little SC, Hughley BB, Park SS. Complications with forehead flaps in nasal reconstruction. Laryngoscope 2009;119:1093-9. https://doi.org/10.1002/lary.20243
  17. Kim GW, Bae YC, Bae SH, Nam SB, Lee DM. A clinical review of reconstructive techniques for patients with multiple skin cancers on the face. Arch Craniofac Surg 2018;19:194-9. https://doi.org/10.7181/acfs.2018.02012
  18. Wollina U. Reconstruction of large facial defects after delayed Mohs surgery for skin cancer. Acta Dermatovenerol Croat 2015;23:265-9.
  19. Park YJ, Kwon GH, Kim JO, Ryu WS, Lee KS. Reconstruction of nasal ala and tip following skin cancer resection. Arch Craniofac Surg 2019;20:382-7. https://doi.org/10.7181/acfs.2019.00486
  20. Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021;22:38-44. https://doi.org/10.7181/acfs.2020.00745