Nasal reconstruction using a paramedian forehead flap

Nasal reconstruction using a paramedian forehead flap is a surgical procedure aimed at reconstructing defects of the nose using a flap of skin and underlying tissue taken from the forehead. This technique is often employed following trauma, cancer resection, or congenital defects that affect the nasal structure. The paramedian forehead flap is a workhorse flap in nasal reconstruction due to its reliable blood supply, the match of skin texture and color, and the ability to reconstruct both the lining and the framework of the nose.

Indications

Nasal reconstruction using a paramedian forehead flap is indicated in cases where there is a significant loss of nasal tissue due to cancer, trauma, or congenital defects. It is particularly useful for large defects that cannot be closed using simpler methods or when previous reconstructive attempts have failed.

Procedure

The procedure involves three main steps: harvesting the flap, transferring the flap to the nose, and flap division and inset.

Harvesting the Flap

The paramedian forehead flap is designed along the forehead, slightly off the midline, to include one of the supratrochlear arteries which ensures a robust blood supply. The size and shape of the flap depend on the nasal defect that needs to be covered.

Transferring the Flap

Once harvested, the flap is transferred to the nasal defect. This is often done by creating a subcutaneous tunnel between the forehead and the nose, through which the flap is passed. Care is taken to ensure that the blood supply to the flap is not compromised during this process.

Flap Division and Inset

After a period of healing, usually 3 to 4 weeks, the flap is divided from its original site on the forehead and fully inset into the nasal defect. Additional refinements to the shape of the nose and the donor site may be performed at this stage or in subsequent surgeries.

Complications

Complications of nasal reconstruction using a paramedian forehead flap include infection, bleeding, flap necrosis, and dissatisfaction with cosmetic outcomes. However, with careful planning and execution, these risks can be minimized.

Recovery

Recovery from nasal reconstruction using a paramedian forehead flap involves a significant period of healing and adjustment. Patients may experience swelling, bruising, and discomfort in both the donor and recipient sites. Follow-up care is crucial to monitor the healing process and address any complications or concerns that may arise.

Conclusion

Nasal reconstruction using a paramedian forehead flap is a complex but highly effective procedure for repairing significant nasal defects. It requires a skilled surgical team, careful planning, and patient cooperation for optimal outcomes. With advances in surgical techniques and postoperative care, patients can achieve significant improvements in both function and appearance of the nose.

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Nasal reconstruction using a paramedian forehead flap

• 
  Flap design
• 
  The initial defect
• Positioning of the flap, during stage 1
  Positioning of the flap, during stage 1
• 
  Full-thickness forehead flap, after stage 1
• Full-thickness forehead flap, before stage 2
  Full-thickness forehead flap, before stage 2
• Elevation of the flap, during stage 2
  Elevation of the flap, during stage 2
• 
  Healed underlying soft tissue and cartilage
• Full-thickness forehead flap, after stage 2
  Full-thickness forehead flap, after stage 2
• End result, lateral view
  End result, lateral view