title: The midline central artery forehead flap: a valid alternative to supratrochlear-based forehead flaps.
abstract: OBJECTIVE
  This study clarifies the pedicle geometry and vascular supply of a midline forehead flap for nasal reconstruction. It reports on the vascular reliability of this flap and its ability to reduce hair transposition to the nose, a major complicating factor of previous forehead flap designs.
  
  
  OBJECTIVE
  To compare the vascular reliability of 3 different pedicle designs of the forehead flap in nasal reconstruction (classic paramedian, glabellar paramedian, and central artery flap design) and evaluate hair transposition rates and aesthetic results.
  
  
  METHODS
  Retrospective analysis of patient data and outcomes retrieved from computer files generated at the time of surgery, supplemented by data from the patient medical records and photographic documentation, from a tertiary referral nasal reconstructive practice, within a secondary-care hospital setting. The study population included all consecutive patients over a 19-year period who underwent primary forehead flap repair of nasal defects, with more than 3 months of postoperative follow-up and photographic documentation.
  
  
  METHODS
  Three sequential forehead flap patterns were used (classic paramedian flap, glabella flap, and central artery flap) for nasal reconstruction over the study duration.
  
  
  METHODS
  Data collected included patient characteristics, method of repair, complications, functional outcome, and patient satisfaction score. For cosmetic outcome, photographic documentation was scored by a medical juror.
  
  
  RESULTS
  No forehead flap had vascular compromise in the first stage. Partial flap necrosis was reported in subsequent stages in 4 patients (1%), with no statistical difference in the rate of vascular compromise between the 3 flap designs. Hair transposition to the nose was lower in the central artery forehead flap (7%) compared with the classic paramedian (23%) and glabellar paramedian (13%) flaps (P < .05). Photographic evaluation in 227 patients showed that brow position (98%) and color match (83%) were good in the majority of the patients.
  
  
  CONCLUSIONS
  In this series, the central artery forehead flap was as reliable (in terms of vascularity) as the glabellar and classic paramedian forehead flap. Its use resulted in a statistically significant reduction in transfer of hair to the nose in our series.
  
  
  METHODS
  3.
authors.affiliation: Department of Otolaryngology, Facial Plastic and Reconstructive Surgery, Nottingham University Hospital, Nottingham, England2Facial Plastic and Reconstructive Surgery, Facial Plastic and Reconstructive Surgery Clinics, Vleuten, the Netherlands.
authors.forename: Callum
authors.initials: C
authors.lastname: Faris
authors.affiliation: Department of Otolaryngology, Facial Plastic and Reconstructive Surgery, Lange Land hospital, Zoetermeer, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Eerden
authors.affiliation: Facial Plastic and Reconstructive Surgery, Facial Plastic and Reconstructive Surgery Clinics, Vleuten, the Netherlands.
authors.forename: Hade
authors.initials: H
authors.lastname: Vuyk
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005546:Forehead / Q000098:blood supply* / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult