Paramedian Forehead Flap for Complex Nasal Reconstruction: Clinical Application and Surgical Outcomes
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Abstract
Background:Reconstruction of major nasal defects is challenging because restoration of skin coverage alone is insufficient to reproduce nasal contour, structural support, and function. The paramedian forehead flap remains a versatile option for defects involving one or multiple nasal subunits and permits staged refinement before definitive pedicle division. This study describes the clinical application of the paramedian forehead flap in a Mexican patient population, with emphasis on reconstructive characteristics, staging, and surgical outcomes.
Methods:An observational study was conducted in 30 patients treated at the Plastic Surgery Department of Hospital General de México between January 2019 and December 2023 for nasal defects requiring forehead flap reconstruction. Demographic characteristics, defect etiology, affected nasal subunits, pedicle laterality, number of reconstructive stages, donor-site management, and postoperative complications were analyzed. Descriptive statistics were used to summarize the study population and reconstructive characteristics.
Results:Thirty patients were included: 18 men (60%) and 12 women (40%), with a mean age of 40.63 years. Oncologic resection was the most frequent etiology (40%), followed by animal or human bites (33.3%) and nasal trauma (20%). Multiple nasal subunits were involved in 70% of patients, with the nasal tip being the most frequently affected subunit (63.3%). An ipsilateral pedicle was used in 28 patients (93.3%). Three-stage reconstruction was performed in 20 patients (66.6%), whereas 10 (33.3%) underwent two-stage reconstruction. Primary donor-site closure was achieved in 28 patients (93.3%). Partial dehiscence occurred in two patients (6.6%), and one patient (3.3%) was considered to have a suboptimal aesthetic result. No total flap losses or major complications were observed.
Conclusions:The paramedian forehead flap provided reliable reconstruction of complex nasal defects involving single or multiple aesthetic subunits, with no total flap losses and a low incidence of minor complications in this series. The versatility of pedicle design, staged reconstruction, and the opportunity for contour refinement support its role as an important reconstructive option for major nasal defects.
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