The midline central artery forehead flap: a valid alternative to supratrochlear-based forehead flaps

Area of Science:

• Plastic surgery
• Reconstructive surgery
• Head and neck surgery

Background:

• Forehead flaps are crucial for nasal reconstruction.
• Hair transposition to the nose is a common complication with traditional forehead flap designs.
• Optimizing flap design is essential for improving outcomes in nasal reconstruction.

Purpose of the Study:

• To compare the vascular reliability of three forehead flap designs: classic paramedian, glabellar paramedian, and central artery flap.
• To evaluate the rate of hair transposition to the nose for each flap design.
• To assess the aesthetic results and patient satisfaction following nasal reconstruction using these flaps.

Main Methods:

• Retrospective analysis of 19 years of patient data from a tertiary referral center.
• Inclusion of consecutive patients undergoing primary forehead flap repair of nasal defects with at least 3 months follow-up.
• Comparison of three sequential forehead flap patterns: classic paramedian, glabella, and central artery flaps.

Main Results:

• No significant difference in vascular compromise or flap necrosis among the three flap designs (1% partial flap necrosis).
• The central artery forehead flap demonstrated a statistically significant lower rate of hair transposition to the nose (7%) compared to classic paramedian (23%) and glabellar paramedian (13%) flaps.
• Excellent aesthetic outcomes were reported, with 98% good brow position and 83% good color match.

Conclusions:

• The central artery forehead flap is a reliable option for nasal reconstruction, comparable in vascularity to other designs.
• This flap design significantly reduces hair transposition to the nose, addressing a major limitation of previous methods.
• The central artery flap offers favorable aesthetic results and patient satisfaction in nasal reconstruction.