Midline Forehead Skin Flap (Seagull Flap)
D. R. MILLARD JR.
In ancient India, many centuries before Christ, the Kumas caste of potters cut forehead flaps for nasal reconstruction following punishment mutilations. Since then, there have been many modifications of the original design, but the seagull-shaped forehead skin flap has advantages that most of the other flaps do not enjoy.
The midline forehead skin flap (and its variations) can serve as cover for any nasal reconstruction from a severe tip and alae loss to a total nasal defect (1, 2, 3, 4). Using this flap, an aesthetic and functional reconstruction can be achieved by creating a nose that blends well with the face and enjoys patent bilateral airways. It is important that the bridge and tip stand proudly, that the alae and columella contours are sculptured, and that the scars are unnoticeable. An advantage of the seagull-shaped forehead flap is that it is cut to cover regional units, thus hiding its tracks in light and shadows by camouflage.
Since some glabellar and frontalis muscle fibers are included in this flap, it could be considered a type of musculocutaneous flap. Its main vascular supply is the supratrochlear bundle based on the medial aspect of one brow. The circulation to the distal portions of the flap is primarily random pattern.
FLAP DESIGN AND DIMENSIONS
The flap is best suited to a forehead of ample height (3 inches from brow to hairline). If the forehead is too narrow, the flap can be set at an oblique angle. The design is created with the body of the seagull placed in a midvertical position on the forehead (Fig. 52.1A). The tail, which is the base of the flap, is placed over one of the supratrochlear vascular bundles.