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2026
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| Online Access: | https://doi.org/10.5281/zenodo.20290166 |
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| author | Plastic Surgery Research Council |
| author_facet | Plastic Surgery Research Council |
| contents | <p><strong>Extent And Safety Of Flap Re-elevation In 2-stage Paramedian Forehead Flap Revisions</strong></p> <p><strong>Abstract:</strong></p><p>PURPOSE: The paramedian forehead flap (PMFF) is an axial-pattern flap supplied by the supratrochlear artery and is the most reliable option for reconstructing complex nasal defects requiring coverage, lining, and support. PMFF�s can be performed in two or three stages depending on the size of the defect and cartilage/soft tissue requirements. The 3-stage PMFF includes an intermediate step that allows thinning and contouring of the flap before pedicle division, maximizing vascular safety. The 2-stage PMFF omits this step, and the flap is divided with minimal thinning, often requiring a revision months later to achieve adequate cosmetic and functional results. Since the flap has been divided from its pedicle prior to revision, it has historically been re elevated up to only 50% during revisions to avoid vascular compromise. Greater re-elevation could allow more precise refinement, but safety has not been systematically evaluated. This study assesses the extent to which 2-stage PMFFs can be safely re-elevated after pedicle division. METHODS: A retrospective review was conducted for all patients who underwent a 2-stage PMFF and at least one revisional procedure from January 2020- June 2025 by a single surgeon at a tertiary academic hospital. Patient demographics, treatment history, and postoperative complications were recorded. Standardized pre- and postoperative photographs were analyzed using ImageJ software to measure flap circumference, which served as a proxy for the extent of flap re-elevation based on the assumption that a greater proportion of the flap�s perimeter being re-elevated corresponds to a greater percentage of overall flap mobilization. Percentage of flap re-elevation was calculated as: % of flap re elevation= (postoperative flap circumference/preoperative flap circumference) x 100. This approach allowed quantification of the relative amount of flap that was surgically re-elevated during revision using noninvasive image analysis. RESULTS: The cohort included 41 patients (mean age 71.3 � 10.9 years), 63.41% female, and 95.12% white. Nasal defects were most commonly caused by basal cell carcinoma (78.04%), followed by squamous cell carcinoma (14.63%) and melanoma in situ (7.3%). Defects frequently involved the tip (80.49%), ala (39.02%), sidewall (29.72%), dorsum (24.39%), soft triangle (21.95%), and columella (4.89%). The overall complication rate was 9.75% (n=4), including two infections and two partial flap necroses, with one case requiring hyperbaric oxygen therapy. No total flap losses occurred. The average time between initial flap inset and pedicle division was 1.26 �.0.4 months, and the average time between pedicle division and revision was 6.48 �4.7 months. The mean flap re-elevation across all revisions was 88.4% � 0.07 (range: 56.02-99.25%). Patients without complications had a mean re-elevation of 90.3% � 0.07, while patients with complications had a mean of 70.6% � 20.6%; this difference was not statistically significant (p=0.39). CONCLUSION: Revisions of 2-stage PMFFs typically require flap re-elevation after pedicle division to optimize functional and aesthetic outcomes. Contrary to historical limitations of 50% re-elevation, our findings demonstrate that re-elevation up to nearly 100% can be performed safely without increasing risks of complications. This approach allows improved contour refinement while maintaining flap vascularity, supporting more aggressive flap mobilization during revision. Back to 2026 ePosters 2026. Plastic Surgery Research Council | All rights reserved | Read the Privacy Policy var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-368251-36']); _gaq.push(['_setDomainName', 'https://ps-rc.org']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-2Z2T841STE'); window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-M1869YKTEZ'); // date/time countdown var countDownDate = new Date('June 4, 2026 08:00:00').getTime(); // Update the count down every 1 second var x = setInterval(function() { // Get today's date and time var now = new Date().getTime(); // Find the distance between now and the count down date var distance = countDownDate - now; // Time calculations for days, hours, minutes and seconds var days = Math.floor(distance / (1000 * 60 * 60 * 24)); var hours = Math.floor((distance % (1000 * 60 * 60 * 24)) / (1000 * 60 * 60)); var minutes = Math.floor((distance % (1000 * 60 * 60)) / (1000 * 60)); // Output the result in an element with id="timeRemaining" document.getElementById("timeRemaining").innerHTML = " " + days + " " + hours + " " + minutes + " Days Hours Minutes "; // If the count down is over, write some text if (distance 2026 Annual Meeting "; } }, 1000);</p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_20290166 |
| institution | Zenodo |
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| publishDate | 2026 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | EP61. Extent And Safety Of Flap Re-elevation In 2-stage Paramedian Forehead Flap Revisions Plastic Surgery Research Council <p><strong>Extent And Safety Of Flap Re-elevation In 2-stage Paramedian Forehead Flap Revisions</strong></p> <p><strong>Abstract:</strong></p><p>PURPOSE: The paramedian forehead flap (PMFF) is an axial-pattern flap supplied by the supratrochlear artery and is the most reliable option for reconstructing complex nasal defects requiring coverage, lining, and support. PMFF�s can be performed in two or three stages depending on the size of the defect and cartilage/soft tissue requirements. The 3-stage PMFF includes an intermediate step that allows thinning and contouring of the flap before pedicle division, maximizing vascular safety. The 2-stage PMFF omits this step, and the flap is divided with minimal thinning, often requiring a revision months later to achieve adequate cosmetic and functional results. Since the flap has been divided from its pedicle prior to revision, it has historically been re elevated up to only 50% during revisions to avoid vascular compromise. Greater re-elevation could allow more precise refinement, but safety has not been systematically evaluated. This study assesses the extent to which 2-stage PMFFs can be safely re-elevated after pedicle division. METHODS: A retrospective review was conducted for all patients who underwent a 2-stage PMFF and at least one revisional procedure from January 2020- June 2025 by a single surgeon at a tertiary academic hospital. Patient demographics, treatment history, and postoperative complications were recorded. Standardized pre- and postoperative photographs were analyzed using ImageJ software to measure flap circumference, which served as a proxy for the extent of flap re-elevation based on the assumption that a greater proportion of the flap�s perimeter being re-elevated corresponds to a greater percentage of overall flap mobilization. Percentage of flap re-elevation was calculated as: % of flap re elevation= (postoperative flap circumference/preoperative flap circumference) x 100. This approach allowed quantification of the relative amount of flap that was surgically re-elevated during revision using noninvasive image analysis. RESULTS: The cohort included 41 patients (mean age 71.3 � 10.9 years), 63.41% female, and 95.12% white. Nasal defects were most commonly caused by basal cell carcinoma (78.04%), followed by squamous cell carcinoma (14.63%) and melanoma in situ (7.3%). Defects frequently involved the tip (80.49%), ala (39.02%), sidewall (29.72%), dorsum (24.39%), soft triangle (21.95%), and columella (4.89%). The overall complication rate was 9.75% (n=4), including two infections and two partial flap necroses, with one case requiring hyperbaric oxygen therapy. No total flap losses occurred. The average time between initial flap inset and pedicle division was 1.26 �.0.4 months, and the average time between pedicle division and revision was 6.48 �4.7 months. The mean flap re-elevation across all revisions was 88.4% � 0.07 (range: 56.02-99.25%). Patients without complications had a mean re-elevation of 90.3% � 0.07, while patients with complications had a mean of 70.6% � 20.6%; this difference was not statistically significant (p=0.39). CONCLUSION: Revisions of 2-stage PMFFs typically require flap re-elevation after pedicle division to optimize functional and aesthetic outcomes. Contrary to historical limitations of 50% re-elevation, our findings demonstrate that re-elevation up to nearly 100% can be performed safely without increasing risks of complications. This approach allows improved contour refinement while maintaining flap vascularity, supporting more aggressive flap mobilization during revision. Back to 2026 ePosters 2026. Plastic Surgery Research Council | All rights reserved | Read the Privacy Policy var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-368251-36']); _gaq.push(['_setDomainName', 'https://ps-rc.org']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-2Z2T841STE'); window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-M1869YKTEZ'); // date/time countdown var countDownDate = new Date('June 4, 2026 08:00:00').getTime(); // Update the count down every 1 second var x = setInterval(function() { // Get today's date and time var now = new Date().getTime(); // Find the distance between now and the count down date var distance = countDownDate - now; // Time calculations for days, hours, minutes and seconds var days = Math.floor(distance / (1000 * 60 * 60 * 24)); var hours = Math.floor((distance % (1000 * 60 * 60 * 24)) / (1000 * 60 * 60)); var minutes = Math.floor((distance % (1000 * 60 * 60)) / (1000 * 60)); // Output the result in an element with id="timeRemaining" document.getElementById("timeRemaining").innerHTML = " " + days + " " + hours + " " + minutes + " Days Hours Minutes "; // If the count down is over, write some text if (distance 2026 Annual Meeting "; } }, 1000);</p> |
| title | EP61. Extent And Safety Of Flap Re-elevation In 2-stage Paramedian Forehead Flap Revisions |
| url | https://doi.org/10.5281/zenodo.20290166 |