A new gold (old) standard for nose reconstruction: The one-stage midline forehead flap – a 13-year retrospective review of results using the central vein and inverted-kite pedicle base modification

Abstract

 Background. A detailed study of the blood supply of the forehead has led to precise landmarks for midline forehead flap planning, similar to the old Indian rhinoplasty landmarks described by Daver and Antia. Further investigation into pedicle rotations has shown that the best technique for one-stage pedicle inset was to use an inverted-kite pedicle base modification of the midline forehead flap. 

Objective. To carry out a retrospective review of all the cases using the one-stage inverted-kite midline forehead flap (OSIKMFF) operated on by the author between January 2006 and September 2018. 

Methods. The retrospective review gathered information on patients’ age, pathology, flap design and complications. 

Results. Twenty patients were included in the study. Most data for 2008 were, unfortunately, lost, but patients whose data were retrievable were included. The average age of the patients was 57 years (range 21 - 84). The male-to-female ratio was 1:1 (10 v. 10). The most common pathology was basal cell carcinoma, which was present in 18/20 (90%) cases, and the remaining 2 (10%) patients had melanoma. Only in two (10%) cases was tissue expansion used before the OSIKMFF. All the flaps survived, and the blood supply was very robust. Complications were minor. 

Conclusion. The one-stage forehead flap using the inverted-kite pedicle base modification is a useful technique, based on meticulously identified safe landmarks, the robust blood supply, meticulous cadaver dissections and clinical experience over many years.