title: Nasal reconstruction: experience using tissue expansion and forehead flap.
abstract: OBJECTIVE
  The forehead is acknowledged to be one of the best, if not the best, donor sites for reconstruction of postoperative nasal defects after ablation in cancer patients. The versatility, color match, and texture are among the benefits of this flap. However, it has 2 major disadvantages: 1) it is stiff, flat, and thicker than normal nasal skin, and thus molding from a 2-dimensional to a 3-dimensional shape is difficult, and 2) there is a donor-site defect that requires coverage using a split-thickness skin graft.
  
  
  METHODS
  In this 5-year study (2004-2009), we modified the 2-stage technique and added an operation before tissue transfer and pedicle division in 48 patients with nasal defects. During the first stage, the tumor was completely excised, and a tissue expander was inserted in the subgaleal plane. After 3 weeks, expansion was initiated. The second operation was performed 12 weeks later. A full-thickness forehead flap was elevated and transposed with primary closure of the donor site. In a third or final stage 3 weeks later, the pedicle was divided. Patient satisfaction and donor site scar was evaluated.
  
  
  RESULTS
  Over the past 5 years, 48 reconstructions for nasal defects were performed using this technique. Nasal defects of the dorsum, alar, tip, columella, and septum were successfully treated. Graft take was successful in all patients.
  
  
  CONCLUSIONS
  The forehead flap technique, in conjunction with tissue expander for nasal repair, has both advantages and disadvantages. The esthetic benefits of this technique must be weighed against the disadvantages.
authors.affiliation: Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Kheradmand
authors.forename: Ata
authors.initials: A
authors.lastname: Garajei
authors.forename: Mohammad Hosein Kalantar
authors.initials: MH
authors.lastname: Motamedi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D002921:Cicatrix / Q000473:pathology; D004954:Esthetics; D005152:Facial Muscles / Q000637:transplantation; D005260:Female; D005546:Forehead / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D050151:Subcutaneous Fat / Q000637:transplantation; D013524:Surgical Flaps / Q000473:pathology; D015626:Tissue Expansion / Q000379:methods*; D015625:Tissue Expansion Devices; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome