Refinements of the application of paramedian forehead flap in nasal defects repair in Asian patients

Abstract

Background Due to the relatively higher tendency of postsurgery scars, insufficient cartilage support, and low surgical acceptability, nasal defect repair with forehead flap in Asian patients needs further study. Objective We aim to determine the necessity of tissue expansion, timing of pedicle division, and the importance of cartilage scaffold reinforcement and scar prevention at the donor site during nasal reconstruction in Asian patients with paramedian forehead flap. Methods A retrospective analysis was performed on patients who underwent nasal reconstruction with forehead flap at our hospital from January 2013 to January 2018. The demographical information, surgery details, and postoperative complications of all patients were recorded. The reconstructed nose, scars, and eyebrow deformities were evaluated by digital photographs, and the overall satisfaction of the patients was documented. Results The study included 15 patients (7 males and 8 females). All nasal defects involved at least two aesthetic units and included seven full‐thickness defects. Only one patient underwent two revision operations. Complications like hematoma, infection, and necrosis were not detected, except in one patient with partial necrosis of the flap. All patients were satisfied with the reconstructed nose and did not report any respiratory dysfunction. No obvious scars or eyebrow deformities were observed. Conclusion Three‐stage full‐thickness forehead flap should be used to repair nasal defects in Asian patients, with immediate cartilage scaffold reconstruction at stage one and reinforcement at stage two. Botox injection into the forehead can refine the scar.

Upper Margin of the Forehead Flap and Its Correlation With Aesthetic Results in Nasal Reconstruction in Fitzpatrick Skin Type III and IV Chinese

“…The limitations of this study are the small number of respondents, and the results may only be applied in East Asian people with mostly Fitzpatrick skin Types III and IV, 2 with relatively limited application in other races or skin types. The unstandardized age of the patients may result in some bias in the assessment because skin quality varies among age groups.…”

“…Modern practices pay attention to the contour, skin texture, symmetry, volume, 3-dimensional structure, and respiratory function of the reconstructed nose, rather than patching the defect only. 2 The forehead flap is widely used for nasal reconstruction because it provides the best color and texture match with relatively inconspicuous scars located at the forehead instead of the central face. [1][2][3][4][5][6][7][8] The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.…”

“…2 The forehead flap is widely used for nasal reconstruction because it provides the best color and texture match with relatively inconspicuous scars located at the forehead instead of the central face. [1][2][3][4][5][6][7][8] The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing. 3,4 The nasal subunit principle, as Burget and Menick suggested in 1985, is a well-accepted technique for achieving optimal cosmetic results in nasal reconstruction.…”

“…This situation is even more complicated, especially in Eastern Asians, who tend to develop hypertrophic or unfavorable scars. 2,4,15,17 To our knowledge, this study is the first of its kind to assess the best position of the upper margin of the forehead flap in nasal reconstruction involving the dorsum and its correlation with aesthetic results in Chinese population, mostly Fitzpatrick Type III and IV.…”

“…Burget and Menick 9 mentioned that the dorsum of the nose extends from the supratip depression to the glabella superiorly, where a transverse wrinkle perpendicular to the procerus muscle may mark its upper limit; nevertheless, it remains unclear where the exact transition is. Although some studies discussed modification of the subunit principle, 2,4,[10][11][12][14][15][16] the upper margins of the forehead flap of the dorsum subunit and its correlation with aesthetic results have never been emphasized in detail. This situation is even more complicated, especially in Eastern Asians, who tend to develop hypertrophic or unfavorable scars.…”