How the Forehead Flap is Done
On this page I'll try to explain how a forehead flap procedure is done. I never received the official doctors detailed report about this part of the process so I'll just tell it how I see it. I did get some of the pictures of when I was on the operating table and you can see some of the procedure from them. Which is mainly what I have to go off of too.
Forehead Flap Surgery starts at 8 am.
The first part of the surgery is where Dr. Kriet removes more of the nose area around where the MOHS surgery was done the day before. The rest of the old scar from the first MOHS surgery that had shrunk so bad is removed and the edges are defined better. Since the MOHS surgery had gone so deep and this part had taken off even more, there wasn't anything left at the tip of my nose to support the new part that was to be put in place.
Dr. Kriet had advised me that this would probably be the case and that his options would be to take some cartilage from the ear to form a ridge to the tip of my nose, or if it worked out he would cut some cartilage from further up in the nose and use that. That would be the preferred method and that is how it worked out. In the pictures you can see how the cartilage was brought down and stitched into place. This has turned out very well because the ridge of my nose looks and feels normal.
The flap itself starts at the inner end of the right eyebrow and extended all the way up into the hairline. Where it starts it was about a half inch wide and as it went up the forehead it got much wider, maybe an inch and a half or so. It should be noted that the strip is never removed completely from the face, it's left attached at the eybrow. Thats becauase the strip is mapped out to follow a good blood vessel and that is key to the flap healing successfully. This lets the blood supply the area from both the inside and from where it's fastened at the edges. The flap stayed pink, warm and healthy looking through out the entire healing process.
Something else I learned about this was just how elastic the skin can be. To be able to take a strip of skin that wide and still pull the edges back together I found to be quite amazing. It also removed alot of the wrinkles that was in my forehead. My wife thought I looked ten years younger!
At the very top of the strip near the hairline, it was really wide. That part couldn't be pulled back together so it was left open. You can see that in the pictures too and again I was surprised how as it healed it filled in. It was rather a deep hole and I thought there was no way it could ever fill in. Now there's just a slight depression there like I'd been hit with a brick as a kid...
So the strip is separated from the forehead and twisted around a half turn, brought down and stitched into the hole on my nose. Now the part that was up in the hairline is at the tip of the nose and where the strip was the widest, that is formed to make the inside of the nostril. Somehow this all worked out because now everything feels right, inside and out.
Out of surgery 4 pm
This operation took around 7 1/2 to 8 hours, it was after 5:30 pm when I woke up in the recovery room. I was very glad to wake up too, phew, at least that part of the ordeal was over. The aide that was by me when I woke up was extremely nice, she stayed by my side for the next several hours until I was released to be moved to a room.