What is a Forehead Flap in Nasal Reconstruction?
WARNING: This post contains graphic images.
Dr. Findley is renowned in our region for her expertise in forehead flap surgery, a procedure for which only a select few board-certified surgeons have the training and experience to consistently deliver excellent results. Given the nose's frequent sun exposure, it's a common site for skin cancer requiring Mohs surgery, making reconstruction in this area critical. In this blog, we’ll guide you through the circumstances that may necessitate this type of nasal reconstruction, what to expect during the procedure, and what the healing process entails.
When is this reconstruction necessary?
It’s often impossible to predict the size and spread of skin cancer into surrounding tissue before surgery. This uncertainty highlights the importance of Mohs surgery, particularly for delicate areas like the nose. Mohs surgery allows for the precise removal of cancer cells while minimizing the excision of healthy skin, ensuring that all cancerous cells are tracked and removed to prevent recurrence
The nose is divided into several subunits, such as the nasal tip and the ala (the lower sides), and it’s crucial to preserve these shapes and contours during any reconstruction. While many skin cancers on the nose can be removed without affecting an entire subunit, allowing for simpler reconstruction methods, cases involving critical defects or significant loss of a subunit require more advanced reconstruction. This approach ensures the most reliable, predictable, and aesthetically pleasing long-term results.
What is a Forehead Flap Procedure?
A forehead flap is a staged procedure that requires multiple surgeries over the course of several weeks or even a month or two. The initial flap procedure is almost always performed on the same day as the Mohs procedure. Dr. Findley, who has performed hundreds of these reconstructions, uses local anesthesia, which is safe and well-tolerated by most patients. The procedure involves templating skin on the superior forehead that can be excised and flipped down to cover a defect or wound on the nose. Once the flap is sutured into place, it’s essential to maintain an optimal blood supply to the nose for several weeks to ensure optimal survival and healing. To preserve this blood supply, a “trunk” of skin connects the forehead flap on the nose to the medial brow area during this period. Most, if not all, of the forehead is then sutured into a fine line, which typically fades well over time. This procedure helps avoid risks associated with simpler repairs for large nasal tip defects, such as contracture with a skin graft and potential disfigurement.
What to Expect During the Procedure
Dr. Findley always conducts a detailed evaluation and discussion with her patients before the procedure to determine the best approach for reconstruction. This includes assessing the skin cancer and anticipating potential necessary modes of reconstruction.
While much of this sounds tough to endure, our patients at Findley Dermatology do wonderfully with the proper attention and care including frequent bandage change and wound check visits. It is crucial to pre-operatively plan ahead for the impact that large central facial bandages and potential swelling and bruising will have on peoples’ daily lives and schedules. The goals of reconstruction after skin cancer removal are always to maintain function, hide and minimize scar lines and respect normal contour and shape of any particular area of the nose. As Dr. Findley often reminds her patients, a “scarless result” can never be guaranteed. However, the goal is always for patients to heal in a way that makes it difficult for their family and friends to even notice that a complex surgery and reconstruction took place. She supports her patients through every aspect of the journey, and is available in the future for minor revisions as needed. Dr. Findley finds that her patients that undergo this mode of reconstruction often become quite close to her and her assistants, as she is able to take a potentially disfiguring skin cancer and provide patients with an excellent long-term result.
Healing and Post-Surgery Expectations
Healing from a forehead flap procedure is a gradual process that can take up to a year for complete scar maturation. Initially, scars may appear more pronounced before they begin to improve in appearance. It’s important to understand that the final result may require more than one procedure or additional “touch-ups” with scar revision or laser treatments to optimize the results.
Throughout your care, Dr. Findley and our team will work closely with you, ensuring that your reconstruction is as seamless and effective as possible. The ultimate goal is to help you return to your normal daily life with minimal disruption to your function and appearance.
If you are considering surgical reconstruction, call our office at 401-415-8586 to schedule a consultation with Dr. Findley.
