[Nasal reconstruction with a three-staged forehead flap: assessment of 16 cases]

We report our experience in 16 patients with a three-staged forehead flap, described by Millard (1974) and Burguet (1992) for nasal reconstruction. We wanted to determine whether the three-stage procedure improves the quality of the final aesthetic result.

Sixteen patients underwent forehead flap nasal reconstruction between June 2002 and February 2005. Reconstruction was performed in three stages, a first stage for the transfer of the forehead flap on the nose, a second stage where the pediculized forehead flap was thinned (day 15) and a third stage for division of the pedicle (day 30). The quality of the final aesthetic result of nasal reconstruction was evaluated 6 months postoperatively, by the patient (patient's satisfaction with the nasal reconstruction [4 points]) and by the surgical team according to the thickness of the flap (3 points), integration of the scars (1 point), color of the flap (1 point) and the redefinition of the natural contour of the nose (1 point). A final 10-point score was used to assess the quality of the result: very good (score above 8), good (score from 7 to 8), average (score from 5 to 7) and poor (score less than 5).

Sixteen nasal reconstructions were followed to completion. Outcome was considered very good in ten (62.5%), good in three (18.7%) and fair in three (18.7%).

Use of the three-stage procedure for forehead flap nasal reconstruction improved the contour of the flap by aggressive defatting of the still pediculized flap, and thus improving the final aesthetic result. Traditionally two stages are used for frontal flaps, with pedicle division at the first stage. This refinement must not be excessive because of the risk of necrosis, the frontal flap often requiring latter defatting. In the three-stage technique thinning is performed at the second stage on a vascularised, bipediculized flap, which makes it possible to obtain the desired refinement without excessive vascular risk.