Extended Forehead Flap With Lowered Pivot Point

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Surgical Anatomy

Background:

• Extensive facial defects often necessitate large donor sites for paramedian forehead flaps.
• Conventional pivot placement above the eyebrow can lead to increased scar burden.
• This study investigates an alternative pivot placement to mitigate donor-site morbidity.

Purpose of the Study:

• To evaluate the geometric benefits of lowering the paramedian forehead flap pivot point.
• To assess complication rates associated with a lowered pivot technique.
• To determine if pivot repositioning reduces donor-site scar length in nasal reconstruction.

Main Methods:

• Retrospective review of patients undergoing nasal reconstruction with paramedian forehead flaps.
• Comparison of conventional pivot placement (above eyebrow) versus lowered pivot placement (midway between eyebrow and medial canthus).
• Photographic analysis using scale-free ratios to quantify flap shortening and scar reduction; complication rates were compared.

Main Results:

• The lowered-pivot cohort (n=14) demonstrated a mean shortening fraction of 0.156 and a mean proportional forehead-scar reduction of 0.432.
• No significant differences in complication rates (hair-bearing transfer, necrosis, scarring) were observed between the conventional (n=16) and lowered-pivot groups.
• Exploratory analysis within the lowered-pivot group showed no association between shortening fraction and complications.

Conclusions:

• Inferior translation of the paramedian forehead flap pivot provides significant geometric advantages.
• Lowering the pivot point effectively reduces the required donor-site incision length.
• This technique offers measurable scar reduction without compromising patient safety or increasing complication rates.