Paramedian forehead flap for the reconstruction of large nasal defects.

Use of the paramedian forehead flap is a versatile and reliable way of reconstructing large nasal defects. Reconstruction is based on the principle of dividing the nose into aesthetic subunits: the tip, dorsum, alae, columella, side walls, and soft triangles. Replacement of entire subunits with a flap results in a superior cosmetic outcome.

Complex nasal reconstruction can be traced back to the works of the ancient Indian surgeon Susruta and to Tagliacozzi during the Renaissance. However, it was not until the beginning of the 19th century that the forehead flap was popularized by Carpue. In our own time, Burget and Menick crystallized the importance and principles of this procedure in their text, Aesthetic Reconstruction of the Nose. (1)

The flap has an axially based pedicle that is richly vascularized, primarily by the supratrochlear artery. Reconstruction with this delayed flap is accomplished in two stages (figure). In the first stage, a large flap from the forehead is raised and rotated 180[degrees] to fill the nasal defect. After 2 to 3 weeks--sufficient time to allow for adequate revascularization from the recipient tissue bed--the flap is divided and inset.

Reference

(1.) Burger GC, Menick FJ. Aesthetic Reconstruction of the Nose. St. Louis: Mosby, 1994.

From the Department of Otolaryngology--Head and Neck Surgery, Beth Israel Medical Center, New York City.