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

Abstract

Summary The paramedian forehead flap is a historic cornerstone of plastic surgery and a mainstay of complex nasal reconstruction. Although initially described as a 2-stage procedure, several procedural advancements and modifications have been proposed, with the most notable being the addition of a third, intermediate stage. Proponents of this 3-stage approach argue that the addition of an intermediate stage improves flap perfusion, expands lining and structural support options, and provides superior aesthetic outcomes. Although this technique has grown in popularity, studies comparing the 2- versus 3-stage approach are relatively scarce in the literature. Existing comparative studies seem to suggest that the 3-stage paramedian forehead flap may have advantages in large, complex nasal defects and patients at high risk for vascular compromise. Additionally, comparative analyses with respect to aesthetic outcome were found to be largely equivocal, suggesting that surgeon comfort and preference should guide flap selection.

Forehead flap reconstruction for post traumatic nasal defects: functional and aesthetic outcomes

“…7 The forehead flap is an axial pattern, interpolated flap based on the supratrochlear artery and drained by its corresponding vein. 8 The flap is elevated in a distal to proximal direction including deep tissue at the most inferior 2 cm, where the vessels course deep to the frontalis muscle, and more superficial tissue superior to that point because the vessels run in a subdermal plane towards the vertex of the scalp. 9 A central nasal defect can be resurfaced on the pedicle of either side, but a unilateral nasal defect is resurfaced with the ipsilateral pedicle to decrease the distance between its pivot point and the defect unless precluded by an old scar within its territory.…”

Paramedian Forehead Flap in Large Nasal Skin Defects: Twenty-years’ Experience

“…Paramedian forehead flaps can be performed in two or three stages according to the surgeon experience and patient’s condition ( 9 , 10 ). In our study, the operations were done in two or three sessions.…”