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At least 55 records · Page 3Linked to original sources
PubMed1996

The expanded forehead scalping flap: a new method of total nasal reconstruction.

The challenge of total nasal reconstruction is particularly formidable in the pediatric patient. Forehead skin is taut, and conventional methods of reconstruction, such as the midline forehead flap, provide a paucity of tissue in this age group. Tissue expansion is well-suited modification to overcome this limitation, but as applied to the midline forehead flap, it does not address the resulting vertical forehead scar. We present a new technique for total nasal reconstruction using an expanded, transversely oriented forehead scalping flap in a pediatric patient. This approach not only provides a generous amount of forehead skin but also limits donor-site morbidity and scarring by orienting incisions transversely at the hairline and within the scalp.

Child↗
PubMed2001

The role of tissue expansion in the management of large congenital pigmented nevi of the forehead in the pediatric patient.

The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the primary modality of treatment. The median age at presentation was approximately 1 year; mean postoperative follow-up was 4 years. Nevi were classified according to the predominant anatomic areas they occupied (temporal, hemiforehead, and midforehead/central); some of the lesions involved more than one aesthetic subunit. The authors propose the following guidelines: (1) Midforehead nevi are best treated using an expansion of bilateral normal forehead segments and advancement of the flaps medially, with scars placed along the brow and at or posterior to the hairline. (2) Hemiforehead nevi often require serial expansion of the uninvolved half of the forehead to minimize the need for a back-cut to release the advancing flap. (3) Nevi of the supraorbital and temporal forehead are preferentially treated with a transposition of a portion of the expanded normal skin medial to the nevus. (4) When the temporal scalp is minimally involved with nevus, the parietal scalp can be expanded and advanced to create the new hairline. When the temporoparietal scalp is also involved with nevus, a transposition flap (actually a combined advancement and transposition flap because the base of the pedicle moves forward as well) provides the optimal hair direction for the temporal hairline and allows significantly greater movement of the expanded flap, thereby minimizing the need for serial expansion. (5) Once the brow is significantly elevated on either the ipsilateral or contralateral side from the reconstruction, it can only be returned to the preoperative position with the interposition of additional, non-hair-bearing forehead skin. Expansion of the deficient area alone will not reliably lower the brow once a skin deficiency exists. (6) In general, one should always use the largest expander possible beneath the uninvolved forehead skin, occasionally even carrying the expander under the lesion. Expanders are often overexpanded.

Facial Neoplasms↗
PubMed2002

Metastatic Crohn's disease of the forehead.

BACKGROUND: Metastatic Crohn's disease (CD) involves the presence of cutaneous granuloma distant from the intestinal lesions related to the disease, usually observed in colonic CD. CASE HISTORY: A 35-year-old female with a permanent ileostomy following proctocolectomy for CD presented in 1999 with a 2-month history of an unusual skin lesion of the forehead. A diagnosis of CD of the ileum, colon, and rectum had been made in 1994. In 1997, a proctocolectomy with ileostomy was performed due to fistulizing severe refractory disease. Microscopic aspects of the intestinal lesions showed deep and fissuring ulcers. After surgery, she went into remission, and a small bowel follow-up in 1999 showed no recurrence, when she presented with the skin lesion of the forehead. MICROSCOPIC DATA: Histological analysis of endoscopical and surgical intestinal specimens showed chronic granulomatous inflammation of the ileum, colon, and rectum, confirming the diagnosis of CD. The forehead skin biopsy was examined by three independent histopathologists. The lesion was composed of numerous small granulomas (Ziehl-Nielsen negative), with no foreign bodies, mainly composed of CD68-positive and periodic acid Schiff-negative monocytes. Despite the low number of lymphocytes, the macroscopical and microscopical aspect of the forehead lesion, together with the clinical history, led to a diagnosis of rare metastatic CD of the forehead. CONCLUSIONS: This case report describes the development of an unusual granulomatous skin lesion of the forehead in a patient with established CD showing no postoperative recurrence.

Adult↗
PubMed1984

The bacterial flora of the forehead and back of Alaskan native villagers in summer and in winter.

The bacterial flora of the forehead and back of Eskimo and Indian villagers in arctic Alaska was determined in midsummer and in winter (temperature -29 degrees to -46 degrees C). Specimens collected by the wet swab method were transported overnight, chilled, to Seattle in buffered diluent with Triton X-100. Control tests showed good survival of principal skin organisms with moderate or large initial populations and a disproportionately greater loss with an initial sparse population. Results of these studies are compared with earlier studies of the forehead flora of a Seattle urban population. On most Alaskan subjects Propionibacterium acnes was more abundant than staphylococci on both sites and both organisms had greater population densities on the forehead than on the back. Population densities for P. acnes varied from none detected to more than 10(6) per cm2 on the forehead and 10(5) per cm2 on the back. For coagulase-negative staphylococci the range was from none detected to more than 10(5) per cm2 on the forehead and the back. The proportion of subjects with relatively abundant or relatively sparse populations of P. acnes and of staphylococci did not change seasonally. Of 51 staphylococcal isolates, 65% were S. epidermidis, 22% S. capitis, and 10% S. hominis. P. saccharolyticus was found on a minority of subjects on both sites. The kinds of organisms found on the forehead and their variable individual population densities were essentially the same on the Alaskan villagers and the Seattle subjects.

Adolescent↗
PubMed2005

Paramedian forehead flap reconstruction for nasal defects.

BACKGROUND: The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects. OBJECTIVE: Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results. METHODS: The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed. RESULTS: Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss. CONCLUSION: With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.

Forehead↗
PubMed2005

The effect of venous pulsation on the forehead pulse oximeter wave form as a possible source of error in Spo2 calculation.

Reflective forehead pulse oximeter sensors have recently been introduced into clinical practice. They reportedly have the advantage of faster response times and immunity to the effects of vasoconstriction. Of concern are reports of signal instability and erroneously low Spo(2) values with some of these new sensors. During a study of the plethysmographic wave forms from various sites (finger, ear, and forehead) it was noted that in some cases the forehead wave form became unexpectedly complex in configuration. The plethysmographic signals from 25 general anesthetic cases were obtained, which revealed the complex forehead wave form during 5 cases. We hypothesized that the complex wave form was attributable to an underlying venous signal. It was determined that the use of a pressure dressing over the sensor resulted in a return of a normal plethysmographic wave form. Further examination of the complex forehead wave form reveal a morphology consistent with a central venous trace with atrial, cuspidal, and venous waves. It is speculated that the presence of the venous signal is the source of the problems reported with the forehead sensors. It is believed that the venous wave form is a result of the method of attachment rather than the use of reflective plethysmographic sensors.

Female↗
PubMed1995

Forehead skin temperature and thermal sensation during exercise in cool and thermoneutral environments.

BACKGROUND: The influence of forehead and mean skin temperature on thermal sensation during exercise in hot, cool, and thermoneutral environments is unclear. HYPOTHESIS: We hypothesized that forehead temperature, in contrast to other skin sites, would contribute significantly to thermal sensation during exercise in hot, cool, and thermoneutral environments. METHOD: Volunteer males (N = 14) performed 30 min of constant load exercise on a cycle ergometer during which thermal sensation, skin and rectal temperatures, and heart rate were collected. Each subject participated in a control (24 degrees C), hot (40 degrees C), and cool (8 degrees C) condition. RESULTS: Significantly higher mean skin temperatures occurred during exercise in the hot condition (M = 37.22 +/- 0.20 degrees C) compared to exercise in the neutral (M = 33.34 +/- 0.51 degrees C) and cool conditions (M = 27.92 +/- 0.22 degrees C). Forehead skin temperature in the neutral and cool conditions was significantly greater than forearm, hand, thigh, and calf skin temperatures (p < 0.05). In the hot condition, forehead temperature was significantly greater than back, chest, upper arm, and hand skin temperatures (p < 0.05). In contrast to the neutral and hot conditions, forehead skin temperature was significantly associated with thermal sensation during exercise in the cool condition (r consistently > 0.67). CONCLUSIONS: We conclude that forehead skin temperature, in contrast to other skin sites, contributed significantly to thermal sensation during exercise in the cool.

Adult↗
PubMed2000

"Deep-forehead" temperature correlates well with blood temperature.

PURPOSE: To evaluate the accuracy and precision of "deep-forehead" temperature with rectal, esophageal, and tympanic membrane temperatures, compared with blood temperature. METHODS: We studied 41 ASA physical status 1 or 2 patients undergoing abdominal and thoracic surgery scheduled to require at least three hours. "Deep-forehead" temperature was measured using a Coretemp thermometer (Terumo, Tokyo, Japan). Blood temperature was measured with a thermistor of a pulmonary artery. Rectal, tympanic membrane, and distal esophageal temperatures were measured with thermocouples. All temperatures were recorded at 20 min intervals after the induction of anesthesia. We considered blood temperature as the reference value. Temperatures at the other four sites were compared with blood temperature using correlation, regression, and Bland and Altman analyses. We determined accuracy (mean difference between reference and test temperatures) and precision (standard deviation of the difference) of 0.5 degrees C to be clinically acceptable. RESULTS: "Deep-forehead" temperature correlated well with blood temperature as well as other temperatures, the determination coefficients (r2) being 0.85 in each case. The bias for the "deep-forehead" temperature was 0.0 degrees C, which was the same as tympanic membrane temperature and was smaller than rectal and esophageal temperatures. The standard deviation of the differences for the "deep-forehead" temperature was 0.3 degrees C, which was the same as rectal temperature. CONCLUSIONS: We have demonstrated that the "deep-forehead" temperature has excellent accuracy and clinically sufficient precision as well as other three core temperatures, compared with blood temperature.

Aged↗
PubMed1996

Skin expansion versus free forearm flap in forehead reconstruction.

The authors present their experience in surgical reconstruction of the forehead cosmetic unit, either with tissue expansion or free tissue transfer. Some of the cases underwent a full reconstruction of the entire cosmetic forehead unit en bloc performed by means of free forearm flap such as in postoncological exeresis and in post-traumatic reconstruction. The other method of choice was tissue expansion. The authors expanded the forehead unit for a giant naevus treatment in a child, and used a bilateral expansion of the forehead for tumour clearance of the middle third of the forehead. Results and problems related to the two techniques are presented and discussed.

Adolescent↗
PubMed1987

Distribution of skin surface pH on the forehead and cheek of adults.

The skin surface pH on the forehead and cheek of 574 men and women aged 18-95 was measured. No differences were found between men and women regarding forehead and cheek pH distribution. The group over the age of 80 showed higher pH values on both the forehead and the cheek. In 89% of the subjects measured, the skin surface pH on the cheek was higher than that on the forehead. The central 90%, i.e., the "representative range", for the population below the age of 80 is between 4.0-5.5 on the forehead and between 4.2-5.9 on the cheek.

Adult↗
PubMedDate not supplied

Endoscopically assisted forehead-brow rhytidoplasty: theory and practice.

Forehead-brow rhytidoplasty has evolved from a procedure primarily advocated for brow ptosis, to one in which a group of deformities are routinely addressed. It has also become evident that the surgical results stem from wide undermining with release of the periosteum and the concomitant alteration of the forehead muscles and not necessarily from skin lifting using elevation/excision ratios. Therefore, with the introduction of endoscopically assisted techniques to plastic surgery, the indications for a long forehead incision and its untoward sequelae have to be reconsidered. The anatomic basis for minimally invasive forehead-brow rhytidoplasty and three types of procedures are discussed. These include Type I--complete, endoscopically assisted forehead-brow rhytidoplasty; Type II--segmental, in conjunction with facelift surgery; and Type III--isolated, frown-muscle modification. The role of fixation (external support, internal suspension, or excision techniques) is described. Results suggest that these options provide a worthwhile alternative to traditional "open" techniques in certain circumstances, although some relevant questions remain unresolved.

Endoscopy↗
PubMed1988

Forehead pulse oximetry compared with finger pulse oximetry and arterial blood gas measurement.

Usual monitoring sites for pulse oximetry involve the fingers, toes, ear lobe, and nasal septum. This study examined the performance of a forehead sensor compared with a finger sensor for the pulse oximeter and arterial blood gas (ABG) analysis. Ten healthy adult volunteers and 22 ventilator-dependent patients were studied. The arterial oxygen saturation detected by forehead pulse oximetry (SpO2) correlated well with finger SpO2 and arterial oxygen saturation (SaO2) determined by arterial blood gas analysis in the healthy volunteers. Forehead SpO2 in mechanically ventilated patients correlated well with finger SpO2 and SaO2 when heart rate detected by pulse oximeter differed less than 10% from apical heart rate. Factors that caused a difference in oximeter-detected heart rate and apical heart rate were extensive tissue edema, head movement, and difficulty securing good tape placement. This suggests that when signal strength is weak, causing poor pulse rate detection, there will also be problems associated with accurate SpO2. The forehead pulse oximeter sensor works well on healthy, well-oxygenated volunteers. Difficulty was experienced when applying and using the sensor on critically ill patients. The reliability of the forehead pulse oximeter sensor has not been established at low saturations.

Adolescent↗
PubMed1991

A systematic aesthetic approach to primary closure of the donor site following transposition of vertical forehead flaps.

Twenty patients underwent transposition of a vertical forehead flap to correct defects of the middle third of the face. The treatment and results are reported and evaluated. Based of the width of the secondary forehead defect, the best technique of direct closure was determined. Simpler cases were resolved by careful application of the basic techniques of plastic surgery--undermining and scalp flap rotation. When a forehead defect larger than 4.5 cm was expected, previous forehead skin expansion seemed advisable. A primary, tension-free suture of the forehead defect was achieved in every case, thus significantly improving the aesthetic outcome of the operation.

Adult↗
PubMed2004

Forehead is as sensitive as finger pulse oximetry during general anesthesia.

PURPOSE: To compare the performance of a forehead probe to a conventional finger pulse oximetry probe in anesthetized patients. METHODS: Eighteen patients participated in the study. Each probe was connected to a Nellcor N-550 pulse oximeter. Anesthesia was induced and maintained with propofol. After intubation, the patients received air to achieve a steady-state of peripheral arterial oxygen saturation (SpO(2)). Ventilation was interrupted to induce a hypoxic state. As soon as one of the two SpO(2)'s decreased to 90%, the patients' lungs were ventilated with 100% oxygen. To evaluate the performance of the two pulse oximeters, time to the lowest (TL), time of recovery (TR) and lag times to beginning of SpO(2) decrease (Lag) were measured. RESULTS: There were no significant differences in TL and TR between forehead and finger pulse oximetry under normal perfusion conditions during general anesthesia. When the axillary artery was compressed to mimic reduced peripheral perfusion, SpO(2) in the forehead decreased sooner than in the finger during hypoxia. The forehead and finger TLs were similar, however, TR was significantly longer in the finger. CONCLUSION: The forehead SpO(2) sensor can be used as an alternative to the conventional finger sensor during general anesthesia.

Anesthesia, General↗
PubMed1987

Use of expanded temporal flaps to resurface the skin grafted forehead.

The forehead flap, whilst providing a reliable method of intra-oral reconstruction, leaves an unsightly donor defect in the skin grafted forehead. We describe a technique of resurfacing the forehead using tissue expansion. Axial pattern flaps of expanded hairless temporal scalp are transposed to the forehead. This technique is likely to have wide applications since no other satisfactory method of resurfacing the entire forehead exists.

Adult↗
PubMed1994

Forehead and forearm skin blood flows in newborn infants measured by laser Doppler flowmetry: short-term variability and relationship to sleep states.

Laser doppler flowmeters were used to measure blood flow in the skin of the forehead and volar surface of the forearm of infants at 2-9 days of age, and at 8-12 weeks of age. At both ages mean skin blood flow was higher during active sleep compared to quiet sleep. In infants up to 9 days of age, mean skin blood flow was higher in forehead skin compared to forearm skin. Skin blood flow was highly variable at both recording sites, and was significantly higher and more variable during active compared to quiet sleep in the forehead, but not in the forearm. The results indicate that recordings of skin blood flow over at least two cycles of active and quiet sleep are needed to describe the normal variation with sleep state. The factors which regulate forehead and forearm skin blood flows may differ in importance between the two sites, perhaps reflecting the different thermoregulatory importance of cutaneous blood flow in the forehead and forearm.

Forearm↗
PubMed1996

Comparison of esophageal, tympanic, and forehead skin temperatures in adult patients.

STUDY OBJECTIVE: To compare esophageal, tympanic membrane, and forehead skin temperatures in patients undergoing elective surgeries. DESIGN: Prospective clinical study. SETTING: Operating room and postanesthesia care unit of a tertiary care teaching hospital. PATIENTS: 40 adult ASA status I, II and III patients requiring anesthesia and surgery. INTERVENTION: Application of crystalline thermometry strips to the forehead of patients. MEASUREMENTS AND MAIN RESULTS: Concurrent forehead skin, tympanic membrane, and lower esophageal temperatures were measured and compared. The overall bias between esophageal and skin temperatures was 0.3 degrees C, between tympanic membrane and skin was 0.5 degrees C, and between esophageal and tympanic membrane was -0.1 degrees C The limits of agreement (precision) between esophageal and skin temperatures were: -1.64 degrees C to +2.32 degrees C, between esophageal and tympanic membrane were: -1.02 degrees C to +0.74, and between tympanic membrane and skin were: -1.48 degrees C to +2.52 degrees C. There was no significant relation between the change in skin temperature and change in esophageal temperature, whereas there was a weak linear relation between change in skin temperature and change in tympanic membrane temperature (y = -0.03 + 0.09, r = 0.12). CONCLUSION: There was a lack of precision between the clinically accepted measurements (lower esophageal and tympanic membranes and the skin temperature measurement. The data suggest that forehead skin temperature is not interchangeable with standard core temperature measurements, and that sole reliance on the forehead skin measurement in the perioperative setting could adversely affect patient care.

Adult↗
PubMed1993

SUNCT syndrome: forehead sweating pattern.

The forehead sweating function has been assessed in SUNCT syndrome--a short-lasting, unilateral, neuralgiform headache syndrome with autonomic phenomena on the symptomatic side (conjunctival injection, lacrimation, etc.). In the three patients (of a total of six) who could be studied during paroxysms, increased evaporation was present on the symptomatic side of the forehead compared to the non-symptomatic side during attacks or to the symptomatic side between attacks. Basal sweating was generally within control limits, so long as the attack frequency was not so high as to influence the interictal level. During attacks precipitated by eating chocolate or sour apple (in the case of one of the patients), forehead sweating was also increased on the symptomatic side. The forehead sweating responses to heating and pilocarpine were without any notable or systematic asymmetries. The forehead sweating pattern in SUNCT syndrome may differ from the patterns in unilateral headaches like cluster headache, on the one hand (in which there is generally an asymmetry during heating and pilocarpine tests), and chronic paroxysmal hemicrania (CPH) and cervicogenic headache, on the other (where there is no systematic increase during attacks.

Aged↗