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Early division of forehead flap pedicle may decrease duration of facial deformity

In patients with nasal defects appropriate for paramedian forehead flap, researchers found division of the pedicle at 2 weeks after initial flap transfer reduced the risk of facial deformity.

Ten patients with a mean age of 68 years underwent reconstruction by a single surgeon. Laser-assisted indocyanine green angiography was used before and immediately following initial flap transfer, before pedicle division and immediately after pedicle division and flap inset, which provided the researchers with data about current blood flow to the prospective flap.

Nine of the patients presented with basal cell carcinoma, and one patient presented with squamous cell carcinoma. Six patients underwent measurement of the forehead donor site prior to incision. In this subset, the mean relative perfusion of the donor site prior to the flap transfer was 61.2%.

In all 10 patients, the mean relative perfusion at the initial flap transfer was 81.4%. At atraumatic pedicle clamping, the mean perfusion was 57.5%. After pedicle division and flap insetting, the perfusion mean was 58.6%.

Among the six patients with measurements of perfusion in the donor site, the researchers also analyzed the mean relative perfusion change between flap stages. The mean change in perfusion after inset of the flap tissue at stage 1 was 9.3%. At atraumatic clamping, the mean perfusion change was −5.1%, and after pedicle division and inset, the change was −1.9%.

The researchers concluded that earlier pedicle division lead to decreased patient morbidity and downtime. – by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.