[The useful forehead, the impaired forehead, but the forehead… repaired!]

Abstract

The forehead, although sometimes hidden by a fringe, is a major region of the face revealing many expressions such as fatigue, surprise, concern, anger… In reconstructive surgery, the forehead is frequently used as a donor site. This article looks at three aspects: the used, traumatised and repaired forehead. The forehead, with its high-quality hairless skin and proximity to the noble structures of the face, is a central donor site. The forehead flap is commonly used for nasal reconstruction, with several variations to meet different needs. Other pedicled flaps, such as the supra-eyebrow flap and the crane flaps, are also used for various facial reconstructions. The forehead can be affected by trauma, burns, vascular lesions and skin tumours. We are particularly interested "en coup de sabre" linear scleroderma, an autoimmune disease that causes cutaneous and subcutaneous fibrosis, sometimes associated with Parry Romberg syndrome. In addition, lesions of the temporal branch of the facial nerve lead to muscular paralysis, affecting the aesthetics and function of the frontal region. Precise knowledge of the anatomy of the nerve pathway is crucial to avoid iatrogenic lesions. The entire arsenal of reconstructive surgery is useful for repairing the forehead. Controlled wound healing, tension suturing and the use of local flaps are key techniques for repairing the forehead. Tension sutures are particularly effective for small losses of substance, and their orientation depends on the location. Advancement, rotation and transposition flaps are used for larger losses of substance. Skin grafts, although less aesthetic, are sometimes necessary. Skin expansion, although socially restrictive, is used to treat congenital giant nevi and increase the surface area of forehead flaps.