Mid-forehead flaps

Anatomical studies of the vascular supply of the central forehead confirm that the supratrochlear artery is the primary axial blood supply of the vertically oriented mid-forehead flap. Mid-forehead flaps, which may be of median and paramedian design, can be based on a single supratrochlear artery. The paramedian design has the advantage of a narrower pedicle base, with greater effective flap length compared with the midline design. However, the scar resulting from repair of the donor defect is, on occasion, less favorable than a more centrally located scar that results from use of a median forehead flap. Whether a median or paramedian forehead flap is used, appropriate contouring and thinning of the flap are essential for an enhanced aesthetic result.