Nasal Reconstruction With Two Stages Versus Three Stages Forehead Fap: What is Better for Patients With High Vascular Risk?

Abstract

In nasal reconstruction, it is necessary to replace all anatomic layers in order to reinstate correct aesthetics. The most apt donor site to use in order to cover the nose has been recognized as forehead skin. Traditionally 2 phases are required to reconstruct the forehead flap; however, an intermediate third phase was described by Millard which is between transfer of the flap and division of the pedicle. These methods will be compared in this study with regard to both complication rates and aesthetic results in high vascular risk patients.46 patients were enrolled in the study, all of whom were undergoing either total or subtotal nasal reconstruction from January 2001 to March 2018. The 2-step technique (2S Group) was performed on 30 patients and the 3-step technique (3S Group) was performed on 16. Evaluation questionnaires were completed by patients and a plastic surgeon who was extraneous to the study to evaluate aesthetic satisfaction. Complications other than flap necrosis such as infection, wound dehiscence and hematoma were recorded. VAS and Likert mean values, used to evaluate aesthetic satisfaction, were examined with a Student t test and were discovered to be relevant. Complication rates studied with Fisher exact test showed no statistically significant difference between the 2 groups. The 3-phase method for nose reconstruction using a forehead flap represents a better functional and aesthetic option for patients at high vascular risk.

Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection

“…The forehead flap pedicle division in the second or third operation also showed no association with this sample results. In contrast, Ribuffo et al 21 and Lo Torto et al 22 demonstrated a better final aesthetic result in patients who underwent the PFF division in the third operation. Both studies showed a similar incidence of complications and total number of operations per patient.…”

Two or Three? Approaches to Staging of the Paramedian Forehead Flap for Nasal Reconstruction

“…Although considered safe, the disruption of the myocutaneous blood supply may pose a risk in vascularly compromised patients, such as current smokers, diabetics, or elderly patients. 4,17 Support grafts are then placed and contoured as necessary. Unlike the 3-stage approach, the flap is not re-elevated for additional contouring or shaping.…”

“…Although these findings were not found to be statistically significant, the authors suggest that the 3-stage approach may reduce the risk of flap complications in smokers, elderly, and diabetic patients. 17 In addition to comorbid medical conditions, defect size and complexity are often cited as potential indications for a 3-stage paramedian forehead flap. In the largest comparative study to date, Stahl et al hypothesized that in large, complex defects, the 3-stage forehead flap would be associated with lower rates of flap necrosis and overall complications.…”

“…Although these findings were not found to be statistically significant, the authors suggest that the 3-stage approach may reduce the risk of flap complications in smokers, elderly, and diabetic patients. 17 …”

Reconstruction of the Nose: Management of Nasal Cutaneous Defects According to Aesthetic Subunit and Defect Size. A Review

“…The procedure can also be used for reconstruction of multiple subunits. It is a staged operation; two-stage reconstruction is more commonly performed, but it also can be performed in three stages in order to reduce complications and enhance the aesthetic outcomes [36][37][38].…”