The midline forehead flap in nasal reconstruction

An ancient Indian medical document, the Sushruta Samhita, describes a technique of using a flap from the forehead for nasal reconstruction. The forehead flap remains the workhorse for major nasal resurfacing today. Contemporary nasal reconstruction with forehead flaps uses the well-established concept of facial and nasal subunits, restoring the three-dimensional morphology by replacing missing tissue with like tissue. This article covers the history of forehead flap surgery, current concepts in flap design, surgical steps, potential complications, defect analysis, lining, framework, and cover as a means of restoring the three-dimensional nasal morphology.