Improvements in forehead flap design for nasal reconstruction

Joseph Carpue introduced us to the use of the forehead flap for nasal reconstruction in 1814 after he read an account of its use in India. The forehead flap was the first pedicled flap to be described in European literature and it set off an immediate search for similar flaps elsewhere on the body. In fact, this initial use of the forehead flap was so inspirational that it has been given credit for the rise of plastic surgery as a specialty. The forehead flap is well situated to replace missing nasal skin due to its excellent vascularity, close proximity, and similar histologic qualities. In fact, it is safe to say the forehead flap is the first choice for reconstruction of nasal defects larger than 2.0 cm in diameter. Over the last 180 years there has been considerable refinement in the under stage and standardization of forehead flap design. This short monograph is intended to provide refinements in forehead flap design which, in these authors' opinion, provide superior nasal reconstruction results while minimizing donor site morbidity. Some of these modifications are fairly subtle while others fundamentally affect the design of a forehead flap. Incorporating these modifications will advance the sophistication of the reconstructive surgeon and improve results.