Axial expanded forehead flaps for the repair of extensive facial defects: a report of 13 cases

Open access


Background: Repair of facial defects is a unique challenge because it is critical that donor tissues match the tissues in the affected region and provide good functional as well as aesthetic outcomes.

Objective: Summarize the outcomes of the use of expanded forehead flaps to repair extensive facial defects in 13 patients.

Methods: Axial expanded forehead flaps pedicled on the superficial temporal vessels and supraorbital and supratrochlear neurovascular bundles were used to repair defects of the nose, eyelids, and mouth. Seven cases involved damage to the nose and lip and six cases involved the forehead and nose. Among the latter six cases, three had skin surface tumors involving the forehead together with the upper eyelid and the nose, in which one was pigmented nevus, one was neurofibroma, and one was hemangioma.

Results: A total of 34 flaps, ranging in size from 2.5-4 cm to 12-9 cm, were used to repair facial defects in the 13 patients (five males, eight females; median age, 32 years). There were no surgical or postoperative complications, and all flaps survived. In all cases, cosmetic and functional outcomes were considered satisfactory.

Conclusion: The expanded forehead flap provides a large amount of tissue with color and texture similar to that of facial structures, and avoids significant donor sight scars. In addition, the extensive blood supply of the forehead helps to ensure flap survival. Expanded forehead flaps are useful for the repair of large facial defects.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Tschoi M Hoy EA Granick MS. Skin flaps. Clin Plast Surg. 2005; 32:261-73.

  • 2. Brodland DG. Paramedian forehead flap reconstruction for nasal defects. Dermatol Surg. 2005; 31:1046-52.

  • 3. Chen EH Johnson TM Ratner D. Introduction to flap movement: reconstruction of five similar nasal defects using different flaps. Dermatol Surg. 2005; 31:982-5.

  • 4. Tan O Atik B Ergen D. Temporal flap variations for craniofacial reconstruction. Plast Reconstr Surg. 2007; 119:152e-163e.

  • 5. Fan J. A new technique of scarless expanded forehead flap for reconstructive surgery. Plast Reconstr Surg. 2000; 106:777-85.

  • 6. Fan J Liu L Tian J Gan C Lei M. Aesthetic full- perioral reconstruction of burn scar by using a bilateralpedicled expanded forehead flap. Ann Plast Surg. 2009; 63:640-4.

  • 7. Huang YX Zhan XH Fan JC Zheng JW Wu ZH Chen JC et al. [Repair of scars in submaxillary region using expanded forehead axial flaps with fascia pedicles carrying bilateral frontal ranches of superficial temporal artery and vein]. Zhonghua Shao Shang Za Zhi. 2010; 26:251-5. [Article in Chinese]

  • 8. Lesavoy MA Kohan E. Total upper and lower eyelid reconstruction using an expanded forehead flap. Ann Plast Surg. 2011; Mar 2. [Epub ahead of print]

  • 9. Weng R Li Q Gu B Liu K Shen G Xie F. Extended forehead skin expansion and single-stage nasal subunit plasty for nasal reconstruction. Plast Reconstr Surg. 2010; 125:1119-28.

  • 10. Gillies H Millard DR. The principles and art of plastic surgery. Boston MA: Little Brown. 1957.

  • 11. Hoffmann JF. Tissue expansion in the head and neck. Facial Plast Surg Clin North Am. 2005; 13:315-24 vii.

  • 12. Fujinori R. Gate flap for the total reconstruction of the lower lip. Br J Plast Surg. 1980;33:340-5.

  • 13. Aytekin A Ay A Aytekin O. Total upper lip reconstruction with bilateral Fujimori gate flaps. Plast Reconstr Surg. 2003; 111:797-800.

  • 14. Rea JL Davis WE Rittenhouse LK. Reinnervation of an Abbe-Estlander and a Gillies fan flap of the lower lip: electromyographic comparison. Arch Otolaryngol. 1978; 104:294-5.

  • 15. Sakai S Sodeda S Endo T Ishii M Uchiumi E. A compound radial artery forearm-flap for the reconstruction of lip and chin defect. Br J Plast Surg. 1989; 42:337-8.

  • 16. Menick FJ. Defects of the nose lip and cheek: rebuilding the composite defect. Plast Reconstr Surg. 1979; 64:692-6.

  • 17. McCarthy J Lorenc ZP Cutting C Rachesky M. The median forehead flap revisited: the blood supply. Plast Reconstr Surg. 1985; 76:866-9.

  • 18. Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Recongstr Surg. 2002; 109:1839-55.

  • 19. Li QF Xie F Gu B Zheng D Lei H Liu K et al. Nasal reconstruction using a split forehead flap. Plast Reconstr Surg. 2006; 118:1543-50.

  • 20. Taylor GL Tempest M. Arteries of the skin. Churchill Livingstone. 1988; p72-84.

  • 21. Burget G Menick F. Aesthetic reconstruction of the nose. Mosby. 1993.

  • 22. Millard DR Jr. Reconstructive rhinoplasty for the lower two-thirds of the nose. Plast Reconstr Surg. 1976; 58:283-91.

  • 23. Menick FJ. Nasal reconstruction with a forehead flap. Clin Plast Surg. 2009; 36:443-59.

Journal information
Impact Factor
5-year IMPACT FACTOR: 0.293

CiteScore 2018: 0.30

SCImago Journal Rank (SJR) 2018: 0.172
Source Normalized Impact per Paper (SNIP) 2018: 0.237

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 150 38 0
PDF Downloads 66 19 0