Application of three-staged paramedian forehead flap in reconstruction and repair of full-thickness nasal defect

Abstract

Objective: To evaluate the application of three-staged paramendian forehead flap technique in reconstruction of severe full-thickness nasal defect. Methods: Clinical data of 7 cases with nasal reconstruction by three-staged forehead flap technique in the First Affiliated Hospital of Xinjiang Medical University and HongKong University Shenzhen Hospital between June 2016 and October 2019 was retrospectively reviewed. All were males aged from 10 to 71 years. There were 4 cases of basal cell carcinoma of the external nose, 2 cases of traumatic nasal defects and 1 case of large rhinophyma. All the operations were performed with the paramedian forehead flap in three stages. In stage Ⅰ, full layered forehead flap was transposed to the nasal detect. Lining flaps were reconstructed with folded forehead skin (n=4), turn-over flap plus septal chondro mucosal pivotal flap (n=2), or bipedicled vestibular skin and nasal mucosa advancement flap (n=1). According to the reconstruction mode of the lining flaps, whether to implant cartilage to reconstruct the external nasal stent at stage Ⅰ was determined. At stage Ⅱ, the folded flaps were partly or completely separated from the covering flaps along the free edges of nasal alar. All the excess soft tissue including subcutaneous fat and frontalis muscle were excised, cartilage grafts were placed or sculpted to make an ideal nasal contour. The covering flaps were then returned on the recontoured, three-dimensional recipient bed. At stage Ⅲ, the pedicles were divided. Descriptive statistical method was used to analyze the data. Results: In all cases, restoration of the nasal contour was remarkably good, no flap necrosis occurred. All patients were followed up for 6 months to 2 years, and the appearance and function of the nose recovered well. All patients were satisfied with their final aesthetic results. Conclusions: Three-staged paramedian forehead flap technique ensures maximal blood supply for the lining flap and the inserted cartilage graft, and restores an ideal three-dimensional nasal contour for reconstruction of large full thickness nasal defects.