Nasal Reconstruction Using a Split Forehead Flap

Background: The pedicle paramedian flap is the most common method used to reconstruct the nose, but secondary operations for debulking are required. In addition, this flap is always limited in length, which makes it hard to form the distal part of the nose. In this study, the authors suggest a split forehead flap with an oblique orientation designed to overcome the disadvantages of the paramedian flap. Methods: From their practice and review of the literature, the authors discovered that there is a cutaneous branch of the supratrochlear vessels that is set out around the orbital rim, travels subcutaneously, and has a rich anastomotic plexus with other vessels. Therefore, the authors designed a myocutaneous forehead flap with an oblique orientation to lengthen it and split it into two flaps: a muscle flap and a skin flap supplied by the supratrochlear vessels and their cutaneous branch, respectively. In six cases, the muscle flap was used to reconstruct the septum-like structure and wrap the cartilage framework; the skin flap was used to form a new nose. In five cases, the forehead flap was elevated and used as a superthin skin flap to form a new nose with distinct subunits without secondary debulking operations. Results: This improved flap was used in 11 cases with 6 to 25 months of follow-up. In all cases, the authors observed the cutaneous branch of the supratrochlear vessels. All patients were satisfied with their new noses. Conclusions: This split forehead flap, with an oblique orientation design, has the advantages of achieving good restoration of nasal contour and building septum-like structures and reducing the number of operations.