ForeheadReconstruction

Mansoor KhanPlastic & Reconstructive SurgeryHMC, Peshawar

Provide coverage to skull while not compromising the aesthetic

function of the forehead

Subunits of forehead

Pre-temporal Supra brow

Glabella

Anterior forehead

Laye

rs o

f the

fore

head

Arteria

l sup

ply o

f the

fore

head

Nerve supply of the forehead

Provision of stable tissue, non hair bearing, similar colour

tissue

Maintaining proper position/shape of the eyebrows

Preservation of smooth/continuous anterior

hairline

Planning incisions along the RSTLs, hairlines, vertical in the

glabella Goals of forehead reconstruction

Serial wound excision

Achieve tumor free wound

Considering radiated areas

Trauma protocol (xrays, CT)

Principles of forehead reconstruction

ForeheadReconstruction

OptionsDirect closure

Closure by secondary intension

Skin grafting

Local flapsDistant flaps

Free flapsTissue expansion

Primary closure

Closure by secondary intension

Split thickness skin grafting

Crane principle based flap

Shutter flaps

Shutter flaps closure

H-flap closure

H-flap closure

H- flap closure

Double rotation flaps

Single rotation flap

Worthen flap

Worthen flap closure

Esser cheek advancement

A-T flaps closure

A-T flaps closure

Transposition flap

3 flaps scalp expansile technique

Trapezius myocutaneous flap

Tissue expansion

ForeheadReconstruction

Microvascular free flaps and prefabrication

Single follicle transplantation

Composite grafting for brow reconstruction

Pedi

cled

flap

for b

row

reco

nstr

uctio

n