[Combined folded paramedian forehead flap in extensive nasal tissue losses: A technical note]

Tissue defects (TD) at the nasal tip, dorsum, and alar regions can result from surgical excisions of cancerous skin lesions, congenital malformations, immunological diseases, trauma, or vascular anomalies. The ideal reconstruction should aim to restore the aesthetic subunits of the nose while minimizing donor site morbidity. Among the available techniques, the plicated paramedian frontal flaps (PPFF), combined with internal mucosal flaps, have proven particularly effective for extensive nasal pyramid tissue defects. This article presents our experience with a three-stage reconstruction technique using the PPFF combined with a mucosal flap for major tissue losses affecting the nasal tip and alar regions.

This monocentric retrospective study reviewed 52 cases of nasal reconstructions performed between January 2019 and January 2024, of which 37 were treated with PPFF alone and 6 with combined mucosal flaps. All patients provided informed consent, and the study was approved by the ethics committee. The parameters analyzed included the types of tissue defects, the type of reconstruction, and aesthetic outcomes. A satisfaction survey was conducted six months postoperatively.

Among the six cases of reconstruction using the combined PPFF and mucosal flap, no cases of necrosis were observed. The average size of the tissue defects was 4cm, with a functional satisfaction rate of 92% and an aesthetic satisfaction rate of 96%. Partial necrosis of the skin graft was noted in 16.5% of cases, but it did not affect the overall result. Donor site scars were well accepted by patients.

The three-stage PPFF reconstruction technique is recommended for complex nasal tissue defects, offering excellent aesthetic and functional outcomes with low donor site morbidity. It simplifies the process by reducing the need for additional mucosal flaps, thus limiting complications and associated complexities.