[Total nostril wing reconstruction: Attitudes evaluation of reconstructive facial surgeons]

Cutaneous nasal defects, often resulting from surgical excisions for cancerous, traumatic, or congenital lesions, represent a major challenge in reconstructive surgery. The aim of this single-center retrospective study was to evaluate surgical practices and factors influencing the choice between two reconstruction techniques : the nasolabial flap (NLF) and the folded paramedian forehead flap (PFF) according to Menick's technique. Between January 2017 and March 2024, 23 patients with full-thickness alar defects, with or without extension to the nasal tip, were included. Patients were divided into two groups : 13 underwent PFF and 10 underwent NLF. Demographic data, comorbidities, histological type (primarily basal cell carcinomas), and aesthetic and functional outcomes were analyzed. PFF was associated with a significantly higher number of aesthetic subunits reconstructed (2.6±0.8 vs. 1.3±0.4, P<0.001) and a greater number of surgical stages (3.6±1.1 vs. 1.4±0.7, P<0.001). Patients in the PFF group were primarily motivated by aesthetic considerations (66 %), while those in the NLF group prioritized the speed of the procedure (50%). An anonymous questionnaire was distributed to 63 head and neck surgeons to explore their preferences and reasons for their choices. The NLF was preferred by 84% of surgeons, mainly due to its simplicity and speed, while 49% opted for the PFF, despite its complexity and the social inconvenience caused by the pedicle before division. The main drawbacks of the PFF were the number of surgical stages (49%), social inconvenience (35%), and donor site scarring (29%). However, the aesthetic outcomes of the PFF were considered superior, particularly for defects involving more than one aesthetic subunit. The use of pre- and postoperative photographs to guide patients was more common among experienced surgeons (57%). In conclusion, although the NLF is more widely used due to its practicality, the PFF remains the technique of choice for complex defects, offering optimal aesthetic results despite its complexity. Clear information and the use of visual aids are essential to assist patients in their decision-making process.