This document discusses various techniques for reconstructing the forehead after trauma or tumor removal. It outlines the goals of forehead reconstruction as providing stable, non-hair bearing tissue of similar color while maintaining eyebrow position and shape. Reconstruction options include direct closure, closure by secondary intention, skin grafting, local flaps, distant flaps, tissue expansion, and free flaps. Specific techniques described include H-flaps, Worthen flaps, A-T flaps, transposition flaps, scalp expansile flaps, trapezius myocutaneous flaps, tissue expansion, and microvascular free flaps.

1. Forehead Reconstruction Mansoor Khan Plastic & Reconstructive Surgery HMC, Peshawar

2. Provide coverage to skull while not compromising the aesthetic function of the forehead

3. Anterior forehead Supra brow Pre-temporal Glabella Subunits of forehead

4. Layers of the forehead

5. Arterial supply of the forehead

6. Nerve supply of the forehead

7. Provision of stable tissue, non hair bearing, similar colour tissue Maintaining proper position/shape of the eyebrows Preservation of smooth/continuous anterior hairline Planning incisions along the RSTLs, hairlines, vertical in the glabella Goals of forehead reconstruction

8. Serial wound excision Achieve tumor free wound Considering radiated areas Trauma protocol (xrays, CT) Principles of forehead reconstruction

9. Forehead Reconstruction Options Direct closure Closure by secondary intension Skin grafting Local flaps Distant flaps Tissue expansion Free flaps

11. Primary closure

12. Closure by secondary intension

13. Split thickness skin grafting

14. Crane principle based flap

15. Shutter flaps

16. Shutter flaps closure

17. H-flap closure

18. H-flap closure

19. H- flap closure

20. Double rotation flaps

21. Single rotation flap

22. Worthen flap

23. Worthen flap closure

24. Esser cheek advancement

25. A-T flaps closure

26. A-T flaps closure

27. Transposition flap

28. 3 flaps scalp expansile technique

29. Trapeziusmyocutaneous flap

30. Tissue expansion

31. Forehead Reconstruction Microvascular free flaps and prefabrication

32. Single follicle transplantation

33. Composite grafting for brow reconstruction

34. Pedicled flap for brow reconstruction