Axial expanded forehead flaps for the repair of extensive facial defects: a report of 13 cases

Background: Repair of facial defects is a unique challenge because it is critical that donor tissues match the tissues in the affected region and provide good functional as well as aesthetic outcomes. Objective: Summarize the outcomes of the use of expanded forehead flaps to repair extensive facial defects in 13 patients. Methods: Axial expanded forehead flaps pedicled on the superficial temporal vessels and supraorbital and supratrochlear neurovascular bundles were used to repair defects of the nose, eyelids, and mouth. Seven cases involved damage to the nose and lip and six cases involved the forehead and nose. Among the latter six cases, three had skin surface tumors involving the forehead together with the upper eyelid and the nose, in which one was pigmented nevus, one was neurofibroma, and one was hemangioma. Results: A total of 34 flaps, ranging in size from 2.5x4 cm to 12x9 cm, were used to repair facial defects in the 13 patients (five males, eight females; median age, 32 years). There were no surgical or postoperative complications, and all flaps survived. In all cases, cosmetic and functional outcomes were considered satisfactory. Conclusion: The expanded forehead flap provides a large amount of tissue with color and texture similar to that of facial structures, and avoids significant donor sight scars. In addition, the extensive blood supply of the forehead helps to ensure flap survival. Expanded forehead flaps are useful for the repair of large facial defects.