Vol. 4 No. 1 (2021): American Journal of Surgical Research and Reviews

Modifications of Paramedian Forehead Flap

Faisal Ashfaq1; Atif Rafique2; Ambreen Arshad3
1Locum Consultant Plastic Surgery, Bradford Teaching Hospital Trust, Bradford D96RJ; 2King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia; 3Consultant primary health care.


  • forehead flap; modifications; complications.

How to Cite

Faisal Ashfaq1; Atif Rafique2; Ambreen Arshad3. (2021). Modifications of Paramedian Forehead Flap. American Journal of Surgical Research and Reviews, 4(1), 16. https://doi.org/10.28933/ajsrr-2021-03-2106


Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them.

Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded.

Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction.

Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.


  1. Nasal reconstruction. Menick FJ. Plast Reconstr Surg. 2010 Apr; 125(4):138e-150e.
  2. Subcutaneous forehead island flap for nasal re-construction. Ebrahimi A, Kalantar Motamedi MH, Nejadsarvari N, Shams Koushki E. Iran Red Crescent Med J. 2012 May; 14(5):271-5.
  3. A new modified method for nasal lining: the Menick technique for folded lining. Menick FJ. Plast Reconstr Surg. 2002 May; 109(6):1839-55
  4. Simultaneous reconstruction of medial canthal area and both eyelids with a single transverse split forehead island flap. Onaran Z, Yazici I, Karakaya EI, Cavusoglu T. J Craniofac Surg. 2011 Jan; 22(1):363-5.
  5. Prefabricated scalping forehead flap with skele-tal support. Fujiwara M, Suzuki A, Mizukami T, Terai T, Fukamizu H. J Craniofac Surg. 2009 Jul; 20(4):1182-5.
  6. Clinical outcomes of suture delay in forehead flap. Isik D, Kiroglu F, Isik Y, Goktas U, Atik B.. J Craniofac Surg. 2012 Jan; 23(1):75-7.
  7. Single-stage forehead flap in nasal reconstruc-tion. Fudem GM, Montilla RD, Vaughn CJ. Ann Plast Surg. 2010 May; 64(5):645-8.
  8. 8 Revisiting the single-stage forehead flap in nasal reconstruction. Park SS. JAMA Facial Plast Surg. 2013 Sep 1; 15(5):383-4.
  9. Experiences with the forehead island flap with a subcutaneous pedicle. Converse JM, Wood-Smith D. Plast Reconstr Surg 1963; 31:521-7.
  10. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Menick FJ. J Surg Oncol. 2006 Nov 1; 94(6):509-14.
  11. Three-dimensional nasal reconstruction using a prefabricated forehead flap: case report. Ala-göz MS, I?ken T, Sen C, Onyedi M, Izmirli H, Yücel E. Aesthetic Plast Surg. 2008 Jan; 32(1):166-71.
  12. Nasal reconstruction using a split forehead flap. Li QF, Xie F, Gu B, Zheng D, Lei H, Liu K, Shen G, Chang TS Plast Reconstr Surg. 2006 Dec; 118(7):1543-50.
  13. Split paramedian forehead flap for medial can-thal reconstruction. Arvind Krishnamurthy. Nat J Maxillofac Surg. 2012 Jul-Dec; 3(2): 241–2.