Practicalities of having a paramedian forehead flap

Hi Dearheart and a very warm welcome to the online community

That's great that you've been given lots of information about your upcoming surgery but nothing beats hearing from others who have already been through this.

I haven't had this procedure but noticed that you hadn't had any replies yet so have looked through the group to see who has had a paramedian forehead flap recently. I've found Teddi has had this procedure so have 'tagged' them into my reply in the hope that they will pop on and tell you about their experience. 

Do you have a date for your op yet?

x

Hi latchbrook

Thank you so much for your reply and for the welcome to the community. 

I'm one of those people who likes to know what to expect so it would be really helpful if anyone was able to share their experiences. I can imagine that once people have recovered they would like to put it all behind them! 

I don't have a date yet for my surgery and have been told there is a 6 to 12 month waiting list. Hopefully it will be closer to 6 months than 12!

Hope you are doing well 

Yes I can imagine that you're hoping for surgery to be sooner rather than later Dearheart. Sometimes you can get cancellations if you're able to more or less go in at the drop of a hat. If you can do that then you could get in touch with the hospital to let them know.

I'm well, thanks for asking. You can read all about my 'journey' with cancer if you want to by clicking on my username.

x

Thank you, that's good advice about cancellations. 

Glad to hear you are doing well. It sounds like you've been through a lot over the last few years. It's very kind of you to use you experiences to support others. 

Hello Dearheart,

I'm sorry you find yourself here but I can tell you that many here can be great support at a difficult time. I have had the Paramedian forehead flap to repair my nose after MOHS for infiltrating basal cell carcinoma. I am happy to answer any questions. The flap repair gave me a very good result but it is a long process that requires patience. 

The most helpful advice I think I can give is to prepare how you will deal with your daily life in the first weeks and months. I was not allowed to do anything that would raise my heart rate or constitute exercise for at least 4-6 weeks. So, plan for housework help and how you will manage getting groceries. I did not feel comfortable leaving the house with the flap in place. I went for short walks but didn't attend social events. I ordered groceries online and hired housekeepers.

Flaps all look a bit different based on the repair needed and facial structure. It is quite a sight. Find pictures to show family or friends so they won't be surprised. If you are employed outside the home, you may need some time off while you recover and learn to care for the flap. For me, it required a lot of gauze, paper tape, frequent cleanup, and just showering takes time and care (but feels wonderful when you are allowed to let water run over the sutures and flap). I was allowed to wash my hair on day 3 when a huge pressure bandage came off. Every day gets easier and gets you closer to a final result. Plan for excellent nutrition so you heal well and find out which scar reducing products they recommend. I suggest thinking of things to entertain yourself if you do spend a lot of time at home. if you wear glasses, think about contacts or a magnifying device because glasses don't fit over a flap. You will sleep on your back propped up for 4-8 weeks. Get some great pillows or a wedge. Plan for Drs visits, a flap detachment surgery at 4 wks and possibly additional laser or revisions of scars as needed. if your flap contains scalp, you will probably need to think about hair removal at the repair site. It seems like ALOT and it is but you will get through it and be amazed at how you heal. Most people would NEVER suspect I had this surgery. Scars fade and there are great cover up makeups until they do. Be good to yourself and feel free to ask anything. I hope this helps. Thinking of you. 

Teddi 

Hello Teddi

Thank you so much for your reply. It is very kind of you. I'm so glad that you had a good result from your surgery. I hope you are doing well.

It's all been a bit of a shock to hear how much work it's going to take after speaking to the surgeon last week. I have moments where I just want to get on with it and get it all over and done with and then moments where the idea of it seems overwhelming. But it has to be done and at some point in the future I know things will be much better than they are currently as the cancer will be gone and my nose will be repaired. 

Thank you for sharing your advice and experiences. It's difficult to get an idea of the realities from just reading the medical information so it's been helpful to read your message to get a better idea of what it will be like. I assume I will be given information about how to clean and care for the flap by the hospital? 

That's a really good idea to spend the time while I'm waiting to get a date for the surgery to prepare and make plans for dealing with day to day life. It's also good advice to prepare my family and friends. I've explained the surgery to them but I think it's quite hard to visualise it as it sounds so odd when you describe it! I think I've been trying to protect them a bit so they don't worry too much about me. But I don't want them to be too horrified when they see me! How long did it take after the flap was detached for you to feel confident about going out and about and people seeing you? 

Doing some practical things like making plans and researching nutrition for healing will help to keep me occupied and take my mind off things while I'm waiting. 

I really appreciate you taking the time to respond and for being so supportive. Thank you. 

Hi Dearheart,

Im happy to help if I can. This is a HUGE shock to everyone I've spoken with who has experienced it. It is definitely overwhelming at first but then you just figure it out and realize life will return to pretty normal eventually. The surgeons office helped explain about cleaning the back side of the flap and eventually it sort of "dried up" on the back and became much less messy. Initially it had a clotting agent applied which slowly disintegrated and was washed away. A few others I have spoken with had a similar flap situation but others had the flap covered the entire time and dressing changes only by the Drs office. I liked having the option to cover it but also leave open to air and clean it myself.

I started going out about 2 weeks after detachment with derma blend cover up and/or flesh colored scar tape covering the impressive early scars. These change a ton over time. I did need another surgical revision of the flap re insertion site on my forehead but my nose looked great pretty early on. It was even a little shorter and better shaped than my old one, haha. I did have to wear silicone nostril forms at night for the first month to keep nostrils from collapsing and septum shifting. 

You will be amazed at how much you heal and change in a relatively short time. I will send you a private message with my email. If you would like to see some photos so you can understand what I'm talking about, just reply with an email. We can't share photos on this site but can send them privately. Photos were a huge help to me to see my progress. I took frequent pics of myself and when I was having a bad day it helped to look at how far I had come. 

Teddi (Tracy)

Actually, I forgot, you accept me on this site as a friend and then I can send a message. I sent you a friend request. : )

Hi I had the MOHs and forehead flap procedure last year and I found the cleaning of the pedicle the hardest part. Washing of hair is easy in the shower and the dressing isn’t like normal bandages that allow water in. 

You definitely have to rest and take the time to heal and should not vacuum or do any heavy housework that involves lowering of the head like washing, cooking etc.

listen to your doctors and stick to their instructions. 

for me the hardest part which I wish I had had advice on was how to clean the pedicle and bandage it after cleaning. 
If you find the cleaning of the pedicle difficult you can arrange for this to be done at the Drs surgery by a nurse. 

Wishing you the very best and should you need any further advice as the stages progress I would be happy to help. 

Helen 

Hi Helen, 

I agree, cleaning the pedicle is tricky. I was most successful with wet q-tips. Initially I was afraid I would be too rough but realized getting it clean required a little more aggressive cleaning. I hope you are well and getting back to life as you knew it before this. It is a long road but eventually works out. Take care,

Tracy