THE FOREHEAD FLAP THE GOLD STANDARD OF NASAL SOFT TISSUE RECONSTRUCTION

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Abstract

Nasal reconstruction is one of the most challenging
aspect of reconstructive plastic surgery because
of its three dimensional nature. Both functional and
anatomical importance of nose should be kept in mind
while reconstructing any defect of nose including skin
cover, framework and lining depending on the magnitude
of trauma.
Nasal skin coverage is further categorized into
aesthetic subunits. There are nine subunits based upon
the transitions in shadow between natural convexities
and concavities where scars are less conspicuous.
Moreover if more than 50% of a subunit is missing,
then it’s better to reconstruct the whole unit for better
aesthetic results. Skin color and texture are other important
variables to be considered while reconstructing
any defect on nose and face.
Use of forehead for nasal reconstruction dates
back to ancient India. Nasal amputation, in 700BC, was
a common punishment for a variety of crimes. Nasal
trauma treatment was first published in medical book
entitled Sushruta Samita1,2,3,4,5. This technique was then
taken to Europe in 1500s and then to US in 1830s by
JM warren6.
Kazanjian in 1930s first described the primary
blood supply of forehead as supratrochlear and supraorbital
arteries and then significant innovations in its design
ensued over next years. Millard, Gillies, Converse
made significant contributions to this forehead flap but
it was Labat who is credited for designing the median
forehead flap based on the unilateral supratrochlear
artery7.
Millard created the paramedian design excluding

Authors: 
Riaz Ahmed Khan Afridi1
Sahibzada Fawad Khan2
Muhammad Uzair1
Mohammad Jehangir Khan3
Mohammad Tahir1
Journal Issue: 

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