Expanded Forehead Stepped Flaps for Delayed Three-Stage Repair of Midface Skin Lesions

The forehead flap is the best flap for nasal defect repair and nasal reconstruction. It is also an ideal option for repairing skin lesions in the midface (including the nasal area, inner area of the cheek, and upper lip of the perioral area). However, the traditional frontal myocutaneous flap is relatively bulky for repairing pure skin lesions. In addition, the original forehead flap is generally not sufficient to cover a large wound area. If a large forehead flap is removed, the donor site cannot be sutured in one stage. In this study, an expanded forehead stepped flap was used to overcome the shortcomings of the traditional frontal myocutaneous flap. In stage one surgery, a rectangular expander (80–100 mL) was implanted on the side of the forehead. The expansion pot was built-in, and the excess expansion amount was 160–200 mL. After 4 weeks of rest, stage two operation was performed to remove the skin lesions in the midface. The pulsation point of the supratrochlear artery on one side was used as the pedicle, and the flap was designed diagonally to the upper region of the opposite side. The flap was designed according to the size and shape of the wound. The distal portion of the flap was separated in the superficial layer of the frontalis muscle, approximately 1.7 cm above the superior orbital edge, and cut into the submuscle. The flap pedicle was cut from the superficial layer of the periosteum to form a stepped flap. Then, the flap was rotated downward to repair the wound in the midface. Five weeks later, stage three of the operation which involved flap pedicle division, was performed. Expanded forehead stepped flaps were used in 12 cases with 6–36 months of follow-up. In all cases, the blood supply to the flaps was good, and their color, texture, and thickness matched well with those of the surrounding skin. All patients were satisfied with the outcome of the repair. Expanded forehead stepped flaps present an ideal option for repairing wounds after large skin lesion resections in the midface since they have multiple edges from a reliable blood supply, easiness to transfer, and well-matched color, texture, and thickness to those of the surrounding skin of the face to no need for many auxiliary incisions.