A new technique of scarless expanded forehead flap for reconstructive surgery

The forehead flap is an ideal flap for reconstructive surgery, especially f or that involving reconstruction of the face and neck. However, it is usual ly limited to use in nasal reconstruction, even when pet-formed in conjunct ion with tissue expansion, because of the severe visible morbidity of the d onor site. In this article, the author discusses his development of a new t echnique of forehead flap, per formed in conjunction with tissue expansion, for reconstructive surgery without visible scarring at the donor site. The technique involved positioning a tissue expander in the forehead pocket un der the occipitofrontal muscle and serially inflating the expander over a p eriod of approximately 4 to 6 weeks. Thereafter, an expanded forehead flap was created from the frontal hairline area on the basis of the location of the superficial temporal vessels and transferred into 16 recipient sites in 13 patients as an island flap (n = 8), a free flap (n = 1), or a local ran dom nap (n = 7). The donor site was closed directly into the frontal hairli ne, without any visible scar. With the author's experience in the use of th e island nap for nasal, facial, and neck reconstruction and of the free fla p for reconstruction in the extremities, the flap could be as large as 8 x 18 cm without inducing flap necrosis or problems with donor-site closure. A ll patients (n = 13) had acceptable donor-site aesthetic results, without v isible scarring. The results indicate that the flap could be a safe, ample, and color-matched flap for reconstruction of the face and neck and could a lso diminish donor-site morbidity to a minimum, without an unsightly visibl e scar. Furthermore, the flap could be formed into a customized free flap, with the above-mentioned advantages, to be transferred to any part of the b ody.