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Redefining Forehead Reconstruction: Functional and Esthetic Outcomes Using a Preexpanded Brachial Artery Perforator

Xinyue Dai1, Zixuan Zhang, Mengqing Zang

  • 1Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

The Journal of Craniofacial Surgery
|August 11, 2025
PubMed
Summary

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Preexpanded brachial artery perforator (BAP) flaps offer a successful solution for reconstructing large forehead defects, achieving excellent aesthetic and functional results with high patient satisfaction.

Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Large forehead defects pose significant reconstructive challenges, risking asymmetry and poor aesthetic outcomes.
  • Existing methods often struggle with matching skin color, texture, and thickness.

Purpose of the Study:

  • To introduce and evaluate a novel method for reconstructing large forehead defects using preexpanded brachial artery perforator (BAP) flaps.
  • To assess the functional and aesthetic outcomes of this reconstructive technique.

Main Methods:

  • A retrospective case series of 17 patients undergoing forehead reconstruction with preexpanded BAP flaps (2012-2024).
  • A three-stage surgical process involving expander insertion, flap elevation and transfer, and pedicle division.
  • The distally based BAP flap was used, with the distal portion covering the defect and the proximal portion tubed.
Keywords:
Brachial artery perforatorfasciocutaneous flapforehead reconstructionperforator plus flap

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Main Results:

  • All flaps demonstrated successful survival without perfusion complications.
  • Excellent flap color, texture, and thickness match to native forehead skin observed post-reconstruction.
  • High patient and family satisfaction reported, with donor site scars well-concealed.

Conclusions:

  • Distally based BAP flaps provide a viable alternative for reconstructing large or complex forehead defects.
  • The technique yields favorable functional and aesthetic results.
  • Further research is warranted to understand the survival mechanisms of extended BAP flaps.