Abstract: Objective　Blood circulation training of the forehead flap prior to pedicle division helps to improve blood supply to the flap. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. To introduce an innovative method designed for ischemic training and compared its efficacy with the clamped rubber band. Methods　The nylon tie blocking method is performed by self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion from the pedicle. The nylon tie and the clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared. Results　A total of 40 forehead flaps were included. The cable tie had less incidence of loosening(8.7% vs. 19.6%, P<0.05) and maintained the pressure more effectively. The pain score for the nylon cable tie was significantly lower than the clamped rubber band (3.25±1.12 vs. 7.05±1.02, P<0.05), especially for pediatric patient (3.50±0.88 vs. 8.60±1.23, P<0.01). All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications. Conclusion　Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, it is recommend to use the nylon cable tie as the first choice for ischemic preconditioning of the forehead flap before the pedicle is broken.

Key words: Forehead flap, 　Blood circulation training, 　Pedicle division, 　Nasal reconstruction