Frontotemporal Flap

EDITORIAL COMMENT

Reference (9) is recommended. It includes a historical perspective and elaborates on and compares the various methods available.

This extremely versatile flap was introduced in 1952 (1) and was subsequently adapted by me for a variety of reconstructive functions in the middle third of the face as well as in the orbital and periorbital areas (2, 3, 4, 5, 6, 7, 8, 9).

INDICATIONS

In experienced hands, the main advantages of the flap are (1) easy adaptability to the requirements of shape and structure of the recipient site, (2) good color match, and (3) inconspicuous scarring at the donor site. In my opinion, these advantages outweigh the fact that the procedure requires three stages.

With the addition of ear cartilage and split-thickness skin grafts to the flap, the tip, columella, septum, and ala can be rebuilt to reproduce the external shape and internal structures of the defect. The most frequent defect I have repaired with the frontotemporal flap is the loss of the tip and one ala caused by an animal or human bite, trauma, or tumor excision.

For repair of the tip, columella, and both alae, either the frontotemporal flap or a composite flap from the ear on a frontoparietal carrier flap is indicated (10, 11, 12, 13). I have also found the frontotemporal flap adaptable for subtotal reconstruction of the nose.

FLAP DESIGN AND DIMENSIONS

The frontotemporal flap consists of two parts: a horizontal superciliary, or carrier, flap and a temporal portion that represents the composite part of the flap used to replace the missing structures at the recipient site. The carrier flap can be cut as narrow as 5 mm in the cutaneous layer, but by beveling the incision on both sides, a subcutaneous flap width of approximately 10 mm is possible.

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