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JAMA Facial Plastic Surgery Classics |

Revisiting the Single-Stage Forehead Flap in Nasal Reconstruction

Stephen S. Park, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Virginia, Charlottesville
JAMA Facial Plast Surg. 2013;15(5):383-384. doi:10.1001/jamafacial.2013.1.
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JAMA Facial Plastic Surgery

The Single-Stage Forehead Flap in Nasal Reconstruction: An Alternative With Advantages.

Stephen S. Park, MD

Arch Facial Plast Surg. 2002;4(1):32-36.

Objective: To review the single-stage forehead flap for patient selection, technique, and main outcome measures.

Methods: Patients undergoing nasal reconstruction between January 1, 1995, and June 30, 2000, were reviewed from medical records, photographs, and personal communication. All work was performed in an academic medical center.

Results: Fifty-one patients had a forehead flap for nasal reconstruction, of which 10 (20%) were repaired in a single stage. All patients had no evidence of small vessel disease, eg, hypertension, diabetes mellitus, or tobacco use. Nasal defects were limited to the upper two-thirds of the nose. The technique is modified from the original description by creating a unilateral, subcutaneous pedicle, wide undermining, and partial resection of the procerus muscle. One patient had superficial epidermolysis at the distal tip of the flap. The remaining 9 patients maintained complete viability with satisfactory outcomes. One debulking procedure was performed to the glabellar area for aesthetic reasons. The average interval for returning to work was 6.6 days compared with the minimal 3 weeks for conventional interpolated flaps.

Conclusion: In select cases, a single-stage, island midline forehead flap can be used safely as an advantageous alternative to the conventional interpolated forehead flap.

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Figure.
Combination of Local Advancement Flaps and Full-Thickness Skin Grafts

A, A 1.5-cm dorsal nasal defect. B, Advancement flap design with standing cutaneous deformities. C, Partial closure with skin graft from standing cutaneous deformity. D, Three-month postoperative result.

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