Expanded Forehead Flaps Based on the Frontal Branch of the Superficial Temporal Artery: Patterns, Techniques, and Outcomes in Cervicofacial Reconstruction

The expanded forehead flap based on the frontal branch of the superficial temporal artery (STA-Fbr) is a versatile technique for reconstructing cervicofacial defects. The aim of this study was to summarize STA-Fbr forehead flap harvesting patterns. Between July 2003 and July 2023, 66 patients (43 males) underwent face and neck defect reconstruction using STA-Fbr-based forehead flaps. These were divided into pattern I (vascular-pedicled) and pattern II (cutaneous-pedicled) flaps. Pattern II was subdivided into unilateral (IIa) and bilateral (IIb) cutaneous-pedicled flaps. Pattern IIa flaps were categorized as traditional or scarless based on pedicle location. Of the 66 flaps, 62 survived without perfusion-related complications. There were 10 Pattern I and 56 pattern II flaps (11 traditional IIa, 19 scarless IIa, and 26 IIb). Venous congestion occurred in 3 pattern I and 1 scarless IIa flap. After conservative management, 3 flaps survived; 1 pattern I flap developed distal necrosis. Defects were located in the temporal region, eyebrow, eyelid, nose, cheek, ear, mentum, and neck. Expanders ranged from 50 to 400 mL (average: 236 mL), with expansion times of 3 to 16 months (average: 5.9 mo). Defect dimensions ranged from 3 × 2 cm to 27 × 8 cm (average: 10.8 × 5.3 cm), and flap dimensions ranged from 4 × 3 cm to 30 × 9 cm (average: 16.3 × 6.6 cm). The STA-Fbr-based forehead flap remains a reliable and effective option for cervicofacial defect reconstruction, delivering functional and aesthetic outcomes. Successful surgery requires thorough anatomical knowledge, meticulous flap design, and in-depth patient communication.