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Facial Flaps

Design

Authors: Liv Schöllhammer, MD, Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD

  • Linear pedicle flaps designed non-adjacent to primary defect
  • Random or, more common, axil blood supply
  • Pedicle is moved under or over intervening tissue
  • Usually requires a multistage procedure where the pedicle is cut in the second stage. Pedicle can be cut after a minimum of 3 weeks
  • When moved under intervening tissue the pedicle must be de-epithelialized to rest in the subcutaneous tunnel

Paramedian forehead flap

This is a short introduction to one of the earliest described flaps in literature. It requires great technique and experience and a more thorough description can be found elsewhere in the literature. 

  • Arterial flap based on the supratrochlear artery
  • Classically used in nasal tip reconstruction
  • Donor site skin tension may be too great for direct closure with the need for partially healing by secondary intent
Figure 1 | paramedian forehead flap

Melolabial interpolated flap

  • Random flap from cheek (melolabial line)
  • Useful in nose reconstruction, especially alar defects
  • The width of the flap is equal to the width  of the primary defect
  • The flap is raised including a minimum of 3mm subcutaneous fat to ensure vascularity
  • The flap can be thinned distally but not proximally on the pedicle to ensure vascularity
Figure 2 | melolabial interpolated flap

Acknowledgements

Illustrations: Marie Helles, med.stud.

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