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| Format: | Recurso digital |
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Zenodo
2026
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| Online-Zugang: | https://doi.org/10.5281/zenodo.20321201 |
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Inhaltsangabe:
- 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. PMFFs can be performed in two or three stages depending on the size of the defect and cartilage/soft tissue requirements. The 2-stage PMFF omits the intermediate thinning 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. 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 to 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 as a proxy for the extent of flap re-elevation. 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%), and sidewall (34.15%). Overall revision complications were minor (9.76%): 2 superficial wound dehiscence, 1 trap door deformity, and 1 partial flap loss. Notably, no cases of total flap loss occurred. The average flap re-elevation was 77.6%. There was no statistically significant difference in complications between flaps re-elevated above or below 80%. CONCLUSION: 2-stage PMFFs can be safely re-elevated beyond the traditional 50% threshold, with an average re-elevation of 77.6% and low complication rates. These findings challenge conventional limits and may allow more aggressive contouring during revision surgery.