Nasal reconstruction remains a large part of my practice and continues to be a challenge, with great variability among different patients and their defects. There are occasions in which the aesthetic demands are relatively high, yet the inconvenience of a 2-stage, or even 3-stage, forehead flap is formidable. This might be especially true with individuals who are actively working in a public arena and are less able to take several weeks away from work.
As an alternative to the traditional forehead flap, one can use the single-stage forehead flap. In this modification, the pedicle is carefully deepitheliaized to create a subcutaneous pedicle and essentially converts the flap into an island flap. The glabellar skin is then elevated and a tunnel created into the nasal defect. The intervening procerus muscle can be removed to allow greater space for the pedicle. The forehead flap pedicle is still based on a unilateral medial brow area, in the region of the supratrochlear artery. As with all forehead flaps, the primary driving blood supply is not only the supratrochlear vessel but the perfusion pressure from the collateral flow in this region, especially the terminal branch of the angular artery. The skin paddle is then tunneled under the intact glabellar skin and fills the nasal defect. The wound is closed circumferentially, and the forehead donor site closed primarily (after undermining). The pedicle has been buried, and the reconstruction is complete. There can be some fullness in the glabellar area that usually resolves with time. Alternatively, the pedicle can be thinned at a future date (but not within 3 weeks).
Park SS. Revisiting the Single-Stage Forehead Flap in Nasal Reconstruction. JAMA Facial Plast Surg. 2013;15(5):383–384. doi:10.1001/jamafacial.2013.1
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