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Scientific Oral Presentation

Facial Plastic and Reconstructive Surgery

Forehead Flaps in Pediatric Facial Reconstruction: Comprehensive Systematic Review, Single-center Case Study, and NSQIP Analysis

Monday, October 19, 2026
1:48 PM - 1:54 PM PT
Location: 404A

    Presenting Author(s)

  • Amy Wang, BA

    Medical Student
    University of Texas Medical Branch
    Katy, TX, United States

    • Co-Author(s)

  • DC

    Davis Chong, BS

    Medical Student
    University of California Davis Medical Center, United States

  • Rahul K. Sharma, MD

    Resident Physician
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

  • SS

    Scott J. Stephan, MD

    Scott Stephan
    Vanderbilt University Medical Center
    Nashville, TN, United States

  • sy

    shiayin F. yang, MD

    Shiayin Yang
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    • Senior Author(s)

  • Priyesh N. patel, MD

    Priyesh Patel
    Vanderbilt Univeristy Medical Center
    Nashville, Tennessee, United States

Disclosure(s):
Amy Wang, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Forehead flaps are a reliable reconstructive option for complex nasal and facial defects in adults; however, data regarding their use in pediatric patients remains limited. To address this gap, the authors performed a systematic review of the literature, analyzed surgical outcomes using the Pediatric National Surgical Quality Improvement Program (NSQIP-P) database, and provided a retrospective review of institutional cases.

Methods: PubMed, Scopus, and ProQuest were searched for studies reporting forehead flap reconstruction in pediatric patients ( < 18 years). Two reviewers independently screened 170 studies according to PRISMA guidelines. Data collected included patient characteristics, defect etiology, flap design, staging, and complications. Additionally, a retrospective analysis of 30-day postoperative outcomes was performed using NSQIP-P data from 2012–2021.

Results: Twenty-seven studies comprising 61 pediatric cases were included after systematic review. Mean age at presentation was 7.6 years. Congenital anomalies, trauma/animal-related injuries, and burns were the most common etiologies. Time to reconstruction ranged from 5 days to 15 years (mean 3.59 years). Most flaps were paramedian (80%), ipsilateral (68%), and performed in three stages (mode 3, mean 2.77). Revision procedures occurred in 21% of cases, while flap failure was rare (3%).

NSQIP-P identified 34 patients with a median age of 8.0 years (IQR 4.1–13.9). Most required inpatient admission (68%) with a median length of stay of 2 days (IQR 1–5). Readmission and unplanned reoperation rates were 15% and 12%, respectively.

Finally, we present a case study of complex nasal reconstruction after a dog-bite using a staged forehead flap.

Conclusions: Forehead flaps are an effective option for complex pediatric nasal and facial reconstruction, although early postoperative readmission and reoperation rates appear higher than in adults. This study represents the first comprehensive analysis of pediatric forehead flap outcomes.