The precise midline forehead flap as a musculocutaneous flap.

The forerunners of the midline forehead flap date back to ancient India. The flap, as modified in this presentation, is often the treatment of choice for reconstructing significant full-thickness defects of the nose. The flap described is designed as a musculocutaneous flap incorporating skin, subcutaneous tissue, muscle, and aponeurosis. The enhanced vascularity of this flap allows precise thinning and tailoring at the distal end. A stepwise description of flap design is outlined.