Delayed pedicle separation in forehead flap nasal reconstruction

Nasal reconstructions with midline forehead flaps are often plagued by inadequate tip projection and excessively thick alar rims. These problems can be overcome by a combination of preliminary tissue expansion, which gains extra length, and delayed pedicle separation, which allows aggressive thinning of alar rims and shaping of the tip while its blood supply is still fully intact. Only when tip-shaping is completed is the pedicle divided and the reconstruction completed. In our experience this combination of increased flap length and improved tip shape has led to better tip projection and superior overall results. Three representative cases that demonstrate these principles are presented.