Complex Nasal Reconstruction: A Methodical Approach to the Three-Stage Paramedian Forehead Flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Otolaryngology

Background:

• Complex nasal reconstructions necessitate meticulous planning and accurate time estimation for each surgical stage.
• Reconstruction of the entire nose, multiple subunits, or substantial subunits typically involves lining replacement and cartilage grafting.

Purpose of the Study:

• To outline the essential components and considerations for staged complex nasal reconstructions.
• To highlight preferred methods for lining coverage and cartilage grafting in nasal reconstruction.

Main Methods:

• Discussion of preferred lining coverage techniques, including the Menick folded paramedian forehead flap (PMFF) and free radial forearm flap.
• Exploration of cartilage grafting timing (first or second stage) in staged nasal reconstructions.
• Emphasis on patient education and surgeon patience for staged procedures.

Main Results:

• The Menick folded paramedian forehead flap (PMFF) and free radial forearm flap are gold standards for initial lining coverage.
• Cartilage grafting is a fundamental element, with flexible timing options within staged reconstructions.
• Successful staged reconstructions require comprehensive patient education and surgeon commitment.

Conclusions:

• Staged nasal reconstruction demands thorough planning, optimal lining coverage (e.g., PMFF), and strategic cartilage grafting.
• Patient and surgeon patience, alongside clear education, are crucial for achieving satisfactory outcomes, potentially including final revisions.