Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)
CPT4 code
Name of the Procedure:
Forehead Flap with Preservation of Vascular Pedicle (e.g., axial pattern flap, paramedian forehead flap)
Summary
The forehead flap procedure involves using a section of the skin from the forehead, with its blood supply preserved, to reconstruct defects in the nasal area or other parts of the face. This technique ensures good blood flow to the new site to promote healing.
Purpose
This procedure is primarily used to repair significant facial defects, often resulting from trauma, cancer resection, or congenital anomalies. The goal is to restore both function and appearance, achieving a natural look with minimal scarring.
Indications
- Significant facial defects, particularly in the nasal area.
- Skin cancer removal requiring extensive reconstruction.
- Traumatic injuries to the face.
- Congenital facial deformities.
Preparation
- Patients may be advised to fast for several hours before the procedure.
- Adjustments in medication might be required, particularly anticoagulants.
- Preoperative assessment including blood tests, imaging studies, and overall health evaluation.
Procedure Description
- The patient is typically placed under general anesthesia.
- The surgeon designs and marks the flap on the forehead, ensuring it includes a vascular pedicle to maintain blood flow.
- The flap is carefully elevated and rotated to cover the defect.
- The donor site on the forehead is partially closed, and sometimes a skin graft is used for coverage.
- The flap is sutured into place, ensuring an optimal match in color and texture.
- Secondary procedures may be planned to refine the reconstruction once initial healing has occurred.
Tools/Equipment: Surgical scalpels, forceps, sutures, cautery devices, possibly skin grafting tools.
Duration
The procedure typically takes around 2-4 hours, depending on the complexity of the case.
Setting
This surgery is usually performed in a hospital or a surgical center equipped for complex reconstructive surgeries.
Personnel
- Plastic or reconstructive surgeon
- Surgical assistants
- Anesthesiologists
- Perioperative nurses
Risks and Complications
- Infection and bleeding
- Flap necrosis (loss of blood supply to the flap)
- Scarring and cosmetic dissatisfaction
- Asymmetry and need for additional surgeries
- Anesthesia-related risks
Benefits
- Effective reconstruction of facial defects.
- Improved aesthetic and functional outcomes.
- Restoration of a more natural appearance. Benefits are often noticeable immediately, but refinement and final results may take several months.
Recovery
- Patients may need to stay in the hospital for a few days post-procedure.
- Follow-up appointments for monitoring the flap and overall healing.
- Pain management typically includes pills or medications.
- Activity restrictions and protection of the surgical site as per the surgeon’s advice.
- Full recovery can take several weeks to months.
Alternatives
- Skin grafts from other body parts.
- Local flaps from adjacent skin areas.
- Prosthetic devices for certain defects. Each alternative comes with its own set of pros and cons in terms of invasiveness, cosmetic outcomes, and suitability for individual cases.
Patient Experience
- Generally, patients will experience swelling, bruising, and some discomfort post-surgery.
- Pain is managed through medication and subsides within a few days.
- Patients may need to adhere to care instructions to ensure proper healing and flap viability, such as avoiding strenuous activities and sleeping with the head elevated.
- Emotional and psychological support may also be beneficial, given the nature of facial reconstruction.