Reconstruction after BCC surgery – Forehead flap
The forehead flap is type of operation that has been around for over 2000 years. Despite being one of the first operations used to reconstruct nose wounds, it is still in use today as it is such a versatile operation.
What is a forehead flap used for?
A forehead flap is usually used to reconstruct nose wounds, especially after large basal cell carcinomas (BCCs) have been removed, or for BCCs that have grown deeply, or through, the nose.
How is a forehead flap performed?
As the name suggests, a forehead flap is taken from the forehead. Broadly speaking a cut is made, starting from the inner aspect of the eyebrow near to the nose. The cut is extended up to the hairline, then curves round to come back down to the eyebrow, about 2cm away from the first cut. The skin is then lifted with the underlying fat and some muscle, but kept attached at the eyebrow. This is called the flap, and it is now twisted round to reach the wound on the nose.
The flap is stitched in place on the nose, and the forehead wound is closed. Sometimes the upper part of the forehead wound is too tight to close, and this is usually left to heal over the next few weeks.
The forehead flap is kept attached to the eyebrow, as this is how the blood flows in and out of the flap. Over the next 3-4 weeks the flap ‘learns to live’ from the nose, and new blood vessels from the nose grow into the flap skin. At this point, the flap can be divided from the eyebrow as the skin can now survive on the nose.
Sometimes, a cartilage graft is also used under the forehead flap, to help give the nose more strength and shape.
What is a cartilage graft?
A cartilage graft is a piece of cartilage, often taken from the ear, that is stitched into the nose to give it more strength and better shape. This can be very important if the nose strength has been lost after basal cell carcinoma surgery to an extent that the nostril is closing in and breathing is difficult. The cartilage graft is usually take from the ear through a cut on the front or back, and the shape of the ear only changes very slightly. Sometimes, for larger grafts, rib cartilage can also be used.
What happens while the forehead flap is attached?
The nose, flap and forehead will usually have dressings on them, and over the first few days the wound can ooze a little so the dressings may need changing every few days. This usually stops after 4 or 5 days. Any non-dissolving stitches will usually be taken out after about 5 or 6 days, then it’s a case of just waiting until the 3 or 4 week stage, when the flap is divided.
How is a forehead flap divided?
At the eyebrow, the forehead flap skin is cut free and the wound is stitched closed. At the nose, the flap is thinned and sculpted to try and match the contours of the nose, and stitched in place. Any non-dissolving stitches are removed at 5-6 days.
What is a 3-stage forehead flap?
This is a forehead flap that is performed in 3 stages, and usually for wounds that have gone through to the inside of the nose (full thickness wounds). The first stage is to raise the forehead flap and stitch it in place on the nose, with the end part of the flap being tucked up to close the lining of the nose. After 3-4 weeks the second stage is performed and the nose part of the flap is split, leaving the lining part in place as by now it has ‘learnt to live’ from the nose. A cartilage graft can now be placed to add strength and shape. The flap is stitched back in place for another 3-4 weeks. At the third stage the forehead flap is divided.
Other BCC reconstruction pages
This information is for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns about any skin growth, or the treatment options, you should consult a medical professional urgently