PRS techniques developed in India as early as 600-700BC (Menick, 2013); this includes images of a paramedian forehead flap
being used to reconstruct a nose.
A paramedian forehead flap was used in 19 defects (Figure 1).
Reconstruction methods according to nasal subunits DORSUM Primary Closure 12 Glabellar Advancement 12 Skin Craft 7 Bilobed Flap 5 Paramedian Forejead Flap 5 Cryotherapy 2 Prosthesis 1 ALAR REGION Nasolabial 34 Bilobed Flap 7 Paramedian Forejead Flap 5 Malar Advancement 3 Skin Graft 3 Composite Graft 1 Secondary Healing 4 Glabellar Advancement 1 Cryotherapy 1 Radiotherapy 1 SIDEWALL Primary Closure 4 Malar Advancement 9 Skin Graft 9 V-Y Advancement 8 Island Flap 8 Bilobed Flap 6 Paramedian Forejead Flap 4 Glabellar Advancement 1 Nasolabial 1 NASAL TIP Skin Graft 16 Bilobed Flap 13 Paramedian Forehead Flap 5 Anchor Flap 1 Glabellar Advancement 2 Cryotherapy 4 Note: Table made from bar graph.
The large facial defect was reconstructed immediately with the vertical paramedian forehead flap
, cheek flap, and nasolabial flap (Figure 1(c)).
Instead, a paramedian forehead flap was used for reconstruction of the internal nasal lining, with rib cartilage grafts used to reconstitute the nasal framework (figure 2).
Based on its excellent skin color match, ease of harvest, and acceptable donor site scarring, the paramedian forehead flap is a well-described and popular reconstructive option for large cutaneous and composite defects of the nose.
Numerous techniques, such as a full thickness skin graft, V-Y flaps, nasolabial flaps, paramedian forehead flap
, and supratrochlear artery perforator propeller flap (STAPP flap) are described in the literature, but a primary aesthetic reconstruction is not often possible [1-5].
The patient underwent two stage nasal reconstruction using a traditional left paramedian forehead flap
that went on to heal uneventfully.
This flap is similar to a radial forearm free flap; the difference is that with the reverse flap procedure, the radial artery pedicle is kept intact until a second stage is performed, analogous to a paramedian forehead flap
Bedside discussion with the patient and his family by the consulting facial plastic surgery service included a recommendation for nasal reconstruction with a paramedian forehead flap
Modern nasal reconstruction of larger (>1.5 cm in diameter) defects frequently involves the use of interpolated flaps, such as the paramedian forehead flap
Use of the paramedian forehead flap
is a versatile and reliable way of reconstructing large nasal defects.