Refinements in Nasal Reconstruction: The Cross-Paramedian Forehead Flap

摘要

INTRODUCTION: Reconstructing large nasal defects, while maintaining an aesthetically pleasing result, can present a reconstructive challenge to the plastic surgeon. The rotational forehead flap has been a workhorse for nasal reconstruction dating back for centuries. The forehead flap provides similar skin color, texture, structure, and reliability in nasal reconstruction. In reconstructing nasal defects the medial forehead flap has disadvantages including a difficult arc of rotation and movement of hair bearing tissue secondary to a lack of adequate length distally. Proximally, the median forehead flap displaces medial eyebrow hair into the medial canthus, sidewall, or gla-bella region. In addition, upon inset of the forehead flap an inverted V shaped scar is visible in the glabella region. These results can be frustrating and disappointing to both the plastic surgeon and the patient. This article describes our modification of the classic median forehead flap. The Cross Paramedian forehead flap provides a smoother arc of rotation, increased length, avoidance of an inverted V-shaped glabella scar and eyebrow distortion. These refinements allow for a more aesthetically pleasing result, while maintaining the reliability and versatility of the flap