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Forehead Flap for Simultaneous Reconstruction After Head and Neck Malignant Tumor Resection

Wang, Lu MD*; Xu, Fengzhi MD*; Fan, Guo-Kang MD, PhD; Li, Wenpeng MD*; Shen, Lei MD

doi: 10.1097/SAP.0000000000000023
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Introduction Oncologic resection of the head and neck malignant tumor often results in complex reconstructive problems that require a reliable flap to restore both the form and function in single-stage operation. The free flap transfer has revolutionized head and neck reconstruction. However, forehead flap pedicled with superficial temporal artery (STA) or supraorbital artery (SOA)/supratrochlear artery (STrA) is a new option for reconstruction of head and neck with its own specific advantages.

Method The forehead flap was applied to reconstruct the defects of the posterior hypopharyngeal wall, external perioral skin and buccal mucosal, and nose and periorbital tissues after malignant tumor resection. Nine of the patients were reconstructed with forehead flap pedicled with STA, 7 of whom underwent postoperative radiation. Eight of the patients were pedicled with SOA (and/or STrA), 1 of whom underwent postoperative radiation.

Results We applied this method in a total of 17 male patients. The mean age of patients was 61 years (range, 47-69 years) with a follow-up time of 12 to 180 months. The biggest defect covered by forehead flap pedicled with STA was measured 10.0 × 6.5 cm. The biggest defect covered by forehead flap pedicled with SOA and/or STrA was measured 9.0 × 7.0 cm. In all 17 patients, no vascular crisis happened and no partial or total flap necrosis was observed. All skin graft area and donor site healed well. No patient experienced flap strictures or fistulas after operation or after radiotherapy. No local recurrence developed during the follow-up time. Functions were assessed by specialist as optimal as no limitation of eyes or mouth opening, and no limitation of food swallowing.

Conclusions The forehead flap provides thin pliable tissue with reliable blood supply and high tolerance to radiotherapy. These advantages make it a valuable option to simultaneously reconstruct the defects after head and neck malignant tumor resection in certain selected patients.

From the Departments of *Plastic and Reconstructive Surgery, and †Otorhinolaryngology, 2nd Affiliated Hospital; and ‡Department of Otorhinolaryngology, 2nd Affiliated Hospital (Binjiang Branch), College of Medicine, Zhejiang University, Zhejiang, China.

Received August 4, 2013, and accepted for publication, after revision, September 24, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Guo-Kang Fan, MD, PhD, Department of Otorhinolaryngology, 2nd Affiliated Hospital College of Medicine, Zhejiang University, 88 Jie-fang Road, Hangzhou 310009, Zhejiang, China. E-mail: fgkxfz@hzcnc.com.

Supported in part by the grant from the project 2013C33132, Science Technology Department of Zhejiang Province, China.

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