Computer-Assisted Forehead Flap Design: Transforming 3-Dimensional Imaging Into 2-Dimensional Templates for Nasal...

The forehead flap is the gold standard for nasal reconstruction and follows the subunit principle. This traditional method relies on surgical experience and involves a steep learning curve. The authors propose a method that uses 3D scanning to directly flatten 3-dimensional images into a 2-dimensional template, enhancing precision and efficiency in forehead flap design. From July 2018 to June 2022, a total of 24 patients who underwent staged forehead flaps for nasal reconstruction were included. Preoperative 3D images were retrieved through a 3D scanner (Artex Space Spider), and the images were flattened with Unfold3D software (Polygonal Design, Version 9) to 2-dimensional templates for forehead flap design. The outcomes were assessed through photographic records and photogrammetry to evaluate the effectiveness of the reconstruction. Among the 24 patients included in the study, 15 males and 9 females were included, with a mean age of 43.75 years. The average follow-up period was 29.54 months (range: 7-57). For hemi-nasal reconstruction, the average differences between the reconstructed side and the contralateral normal side were 6.14% in alar width, 4.20% in alar height, and 2.23% in the alar area. The operative time was reduced by 15 minutes for single-subunit reconstructions and ~30 minutes for total nasal reconstructions. Postoperative complications included 2 cases of partial flap infection, both of which resolved with appropriate wound care. Computer assistance, which involves flattening the 3D structure into a 2D template, streamlines forehead flap planning for nasal reconstruction, reducing the operative time while achieving satisfactory outcomes.