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Two-stage paramedian forehead flap remains gold standard in nasal reconstruction

In a retrospective review in Dermatologic Surgery, researchers found no comprehensive evidence to suggest an enhanced aesthetic result from three-stage forehead flap technique when compared with the two-stage technique.

The data consisted of 102 consecutive nasal reconstruction patients who underwent either two-stage or three-stage paramedian forehead flap technique with a follow-up evaluation of at least 6 months.

Self-assessment questionnaires were distributed to 100 patients, of which 70 responded: 25 had undergone the two-stage procedure and 45 had undergone the three-stage procedure.

The intermediate operation was performed 3 weeks after the first stage in the three-stage group. After an additional 3 weeks, the pedicle was divided and inserted.

Two independent board certified plastic surgeons completed blinded assessments of the aesthetic outcome.

There was no difference between the groups in postoperative functional symptoms.

The nasal ala had more satisfaction in the two-stage group. Otherwise, satisfaction with nasal subunits were comparable between groups.

Researchers found no difference in overall satisfaction between the two groups.

Twenty-nine patients reported hair growth on the flap (10 in two-stage, 19 in three-stage) and 18 had the columella reconstructed.

Donor-site scar appearance was satisfactory in 79% of patients overall.

Patient evaluation for flap hair growth, donor site scar appearance and flap color match were comparable, according to researchers.

Using standard blinded evaluation, natural flap thickness was determined inconspicuous for 51% of patients: 16in the two-stage group and 20in the three-stage group.

In older patients, the flap thickness appeared more natural.

Alae nasi and nasal tip symmetry was similar in both groups.

When using a numeric rating scale from 1 to 10, the overall nasal appearance satisfaction did not differ between groups.

Blinded assessors found more inconspicuous scarring in the two-stage group (92%) vs. the three-stage group (71%). – by Abigail Sutton

Disclosure: The researchers reported no relevant financial disclosures.