Bipedicled Preexpanded Forehead Flaps for Simultaneous Reconstruction of Total Nasal and Upper Lip Subunits: A Novel Approach to Complex Facial Resurfacing

Weijie Su; Peiru Min; Parviz Sadigh; Luca Grassetti; Davide Lazzeri; Krishna Munnee; Zheming Pu; Yixin Zhang

doi:10.1055/s-0036-1583933

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2016; 32(05): 411-414
DOI: 10.1055/s-0036-1583933

Original Article: WSRM 2015 Scientific Paper

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bipedicled Preexpanded Forehead Flaps for Simultaneous Reconstruction of Total Nasal and Upper Lip Subunits: A Novel Approach to Complex Facial Resurfacing

Authors

Weijie Su

¹Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
Peiru Min

¹Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
Parviz Sadigh

²Department of Plastic and Reconstructive Surgery, The Royal London Hospital, London, United Kingdom
Luca Grassetti

³Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Italy
Davide Lazzeri

⁴Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
Krishna Munnee

¹Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
Zheming Pu

¹Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
Yixin Zhang

¹Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

Abstract

Background Reconstruction of the central facial subunits is a complex and challenging task. In cases in which both the nasal and upper lip subunits are involved, a technique that can reconstruct both aesthetic units with tissue of similar color and texture from a single donor site will be ideal. In this article we present our experience with the bipedicled preexpanded forehead flap for simultaneous nasal and upper lip resurfacing.

Patients and Methods Between January 2012 and January 2015 we used this technique in the simultaneous reconstruction of total nasal and upper lip subunits in five patients. All cases were for burns scar resurfacing.

Results Good aesthetic results were achieved in each of our five cases to date and no complications were encountered. All donor sites closed primarily with aesthetically pleasing well-concealed linear scars. In all cases small modifications such as philtral shaping and further flap thinning were performed under local anesthesia between 6 and 12 months postoperatively

Conclusion The preexpanded forehead flap provides an unparalleled color and texture match when it comes to facial resurfacing. When both total nasal and upper lip resurfacings are required, it is possible to achieve this in a single sitting from a single donor site by using a bipedicled preexpanded forehead flap.

Keywords

bipedicled preexpanded flap - forehead flap - head and neck - nose - lips - facial resurfacing

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References

References
1 Gonzalez-Ulloa M, Castillo A, Stevens E, Alvarez Fuertes G, Leonelli F, Ubaldo F. Preliminary study of the total restoration of the facial skin. Plast Reconstr Surg (1946) 1954; 13 (3) 151-161
2 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (2) 239-247
3 Rahman M, Jefferson N, Stewart DA, Oliver R, Walsh WR, Gianoutsos MP. The histology of facial aesthetic subunits: implications for common nasal reconstructive procedures. J Plast Reconstr Aesthet Surg 2010; 63 (5) 753-756
4 Gillies HD, Millard DR. The Principles and Art of Plastic Surgery. 1st ed. Boston, MA: Little, Brown; 1957
5 Fujiwara M, Nagata T, Fukamizu H. Hemiforehead flap for reconstruction of composite facial defects. J Craniofac Surg 2012; 23 (4) e369-e371
6 Menick FJ. Defects of the nose, lip, and cheek: rebuilding the composite defect. Plast Reconstr Surg 2007; 120 (4) 887-898
7 Yoshihiro S, Kenichi N, Toshiaki N. Reconstruction of larger nasal defects together with the nasal lining and the upper lip using the split-scalping forehead flap: a new technique. J Plast Reconstr Aesthet Surg 2011; 64 (8) 1108-1110
8 Wang L, Xu F, Fan GK, Li W, Shen L. Forehead flap for simultaneous reconstruction after head and neck malignant tumour resection. Ann Plast Surg 2014; . PMID: 24691334
9 Washio H. Retroauricular-temporal flap. Plast Reconstr Surg 1969; 43 (2) 162-166
10 Yotsuyanagi T, Yokoi K, Urushidate S, Sawada Y. Functional and aesthetic reconstruction using a nasolabial orbicularis oris myocutaneous flap for large defects of the upper lip. Plast Reconstr Surg 1998; 101 (6) 1624-1629
11 Kumar P. L-shaped scalp flap for moustache reconstruction in a patient with an acid burn of the face. Burns 1996; 22 (5) 413-416
12 Iñigo F, Jimenez-Murat Y, Rojo P, Ysunza A. Frontotemporal fasciocutaneous island flap for facial aesthetic subunit reconstruction. J Craniofac Surg 1999; 10 (4) 330-336