Staged Paramedian Forehead Flap Reconstruction of a Large Oncologic Nasal Defect: A Case Report

Nasal reconstruction after oncologic resection presents a significant surgical challenge, particularly for defects exceeding 1.5 cm, which frequently require interpolated flaps, such as the paramedian forehead flap (PFF), given the need to restore both form and function. The PFF, a historical workhorse in nasal reconstruction, derives its reliability from an axial pedicle based on the supratrochlear artery, providing robust perfusion and an excellent skin match for large and complex nasal defects. We report the case of an 81-year-old male with basal cell carcinoma of the right nasal ala. Wide local excision resulted in a full-thickness defect involving external skin, structural cartilage, and internal lining. A staged reconstruction was performed. In the first stage, a vertically oriented PFF based on the right supratrochlear artery was elevated. Auricular cartilage was harvested to restore the nasal framework, while local mucosal advancement flaps reconstituted the internal lining. The PFF was then inset to reconstruct the external skin. Pedicle division and flap refinement were carried out three weeks later. The postoperative course was uneventful. At six-month follow-up, the patient demonstrated excellent nasal contour, preserved airway function, and no evidence of recurrence. Donor-site morbidity was minimal and well tolerated. Reconstruction successfully restored all three layers of the nasal wall, with high satisfaction reported by both the patient and the surgical team. This case supports the role of the PFF as a workhorse for multilayer nasal reconstruction, yielding predictable outcomes with favorable aesthetic integration.