Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Neurovascular islanded lateral forehead flap for the reconstruction of head and face – A case series (1493)

Samitha Prasad Iddagoda Hewage Don 1 , Yasas Abeywickrama 2
  1. Plastic and Reconstructive Surgery Department, Waikato DHB, Hamilton, Waikato, New Zealand
  2. Plastic and Reconstructive Surgery Department, Colombo South Teaching Hospital, Colombo, Sri Lanka


Forehead is an excellent donor site for soft tissue reconstructions in head and face surgery. Lateral forehead flaps are based on the Frontal(Anterior) branch of the Superficial Temporal Artery(FSTA) with its accompanying superficial veins and branches of Auriculotemporal nerve(ATN).


Three patients were included in this study.

  • 69y male and a smoker who had an advanced maxillary antral adeno-carcinoma and needed resection and cover for the base of the skull,
  • 49y male who had contracted, scared eyelids after acid burn injury with globe rupture needing reconstruction of eyelids and eye socket for prosthesis,
  • 32y male with a parietal area scalp pressure ulcer after complicated traumatic brain injury and craniectomy.

Operative technique:- The STA and FSTA was surface marked using hand held Doppler delineating its subcutaneous course. Appropriate size flap was designed around FSTA branch which extended to the midline anteriorly and above supra-brow line.

Flap harvest was done in retrograde fashion from the anterior midline subcutaneously bellow the artery preserving frontalis muscle and aponeurosis. Flap was narrowed laterally and islanded into its neurovascular pedicle which contained FSTA/STA with superficial vein and ATN. Then the pedicle dissection was performed up to 2-3 cm subcutaneously to have a greater freedom of flap mobility. Flap insertion was done in layered closure after de-epithelializing buried segments.


In the first patient, flap reach was adequate to cover the roof of the orbit internally up to the ipsilateral lacrimal fossa, where as in the second, flap reached medial canthal ligament easily to reconstruct contracted eyelids. In the third case parietal area pressure ulcer was comfortably covered with the flap. Donor site skin grafting was done. There were no complications and no flap or graft losses.


Neurovascular islanded lateral forehead flap is a versatile and reliable flap with a wide coverage.