[Paramedian forehead flap for the reconstruction of extensive nasal defects]

Paramedian Frontal Flap Reconstruction for Nasal Defect Following an Accidental Amputation

This case report aims to present the successful reconstruction of a nasal defect in a 56-year-old male patient who suffered a partial nasal amputation due to a domestic accident involving a grinding wheel. The reconstruction was carried out using a paramedian frontal flap in a two-stage surgical process. Initially, the flap was designed and customized to match the dimensions of the defect, with a pedicle width of approximately 1.5 cm vertically. The flap was elevated in a distal-to-proximal manner, starting with subcutaneous dissection and progressing to periosteal dissection proximally. Weekly dressing changes were made using fatty gauze and fusidic acid ointment. Four weeks postoperatively, the flap pedicle was divided, and the brow was repositioned. At the six-month follow-up, the patient showed satisfactory clinical outcomes with no functional complaints and was very pleased with the aesthetic result. Paramedian frontal flap reconstruction is a dependable technique for addressing nasal defects following traumatic amputation, providing favorable functional and aesthetic results. This case highlights the importance of careful surgical planning and technique in achieving successful facial reconstruction.

An original procedure for orbitonasal cutaneous infiltrative tumor repair, using combined forehead and melolabial propeller flaps

INTRODUCTION

Resections of cutaneous tumors in the medial orbitonasal region can be transfixing. Repairs using a single local flap run the risk of failure and that of secondary sinonasal fistula, especially in cases of surgery on a radiated field. We propose an original and reliable repair procedure using two pedicled regional flaps vascularized by two distinct arterial systems clinched together to reconstruct the mucosal and cutaneous planes.

MATERIALS AND METHODS

A first melolabial propeller flap (MPF) with a superior perforating pedicle was elevated and the cutaneous side was sutured to the deep plane of the loss of substance (mucosal lining). A second homolateral or contralateral paramedian forehead flap (PFF) was then lifted and sutured over the first flap (superficial plane). The forehead pedicle flap was divided at 1 month.

RESULTS

No trophic complication or failure was recorded on two patients. The 7-year carcinologic, aesthetic, and functional results were satisfying.

CONCLUSION

This technique involving the superimposition of two local flaps, vascularized by two different arterial systems, appears to offer a simple and reliable repair technique for transfixing cutaneous losses of substance in the medial orbitonasal region. It could be used in the first-line treatment, particularly if an additional radiotherapy is to be performed.

Usefulness of the Paramedian Forehead Flap in Nasal Reconstructive Surgery: A Retrospective Series of 41 Patients

INTRODUCTION

Surgical reconstruction of the external nose, a common site for nonmelanoma skin cancer, is difficult. Oncologic surgery often leaves large skin defects, occasionally involving the underlying cartilage and nasal mucosa. We describe our experience with the paramedian forehead flap for reconstruction of nasal defects.

METHODOLOGY

We performed a retrospective study of consecutive patients in whom a paramedian forehead flap was used to repair surgical defects of the nose between July 2004 and March 2011. We describe the clinical and epidemiologic characteristics, the surgical technique, complications, secondary procedures, and cosmetic results.

RESULTS

The series comprised 41 patients with a mean (SD) age of 67 (10.36) years. The majority were men (male to female ratio, 2.4:1). Associated risk factors included diabetes in 27% of patients, cardiovascular risk factors in 49%, and smoking or drinking in 19.5%. The tissue defects were distal in 80% of cases and nonpenetrating in 78%. The mean (SD) diameter was 21.6 (6.78) mm. Early postoperative complications occurred in 14.6% of patients and late complications in 31.7% (trap door effect in 22% and hair transposition in 19%), with a need for Readjustment in a second operation was needed in 19.5% of patients. The cosmetic results were considered acceptable or excellent in 90.2% of cases.

DISCUSSION

The paramedian forehead flap is versatile and provides skin of a similar color and texture to that of the external nose. It has a reliable vascular pedicle that guarantees the viability not only of the flap but also of other tissues that may be used in combination, such as chondromucosal or chondrocutaneous grafts. Revision of the technique in a second operation may sometimes be required to achieve an optimal result.