BACKGROUND:: The forehead flap is an important tool in nasal reconstruction. We present objective data and recommendations based on over a decade of consecutive forehead flap nasal reconstructions performed by the senior author (J.F.T.). Additionally, we separate the technique into its individual steps and provide details of his approach to each. METHODS:: We performed a retrospective analysis of patients who underwent nasal reconstruction with forehead flap over a ten-year period by the senior author (J.F.T.). Each case was evaluated for defect location, pedicle design, time of division, number of stages, use of cartilage grafts, lining reconstruction, donor site closure, and complications. RESULTS:: 420 patients underwent forehead flap nasal reconstruction. Average time to pedicle division was 32 days. Three-fourths of patients completed reconstruction in two stages. Defects most commonly involved nasal ala and tip. Approximately half of patients received cartilage grafts and half underwent lining reconstruction. There were 16 complications, ranging from partial flap loss to one post-operative death. CONCLUSION:: Confidently grasping the nuances of forehead flap nasal reconstruction arms the reconstructive surgeon with a reliable tool that can effectively treat a variety of defects. It is safe to use in an outpatient setting even in elderly patients. Recommendations include ipsilateral flap design and turn-in component as first choice for lining replacement.
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