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Low Median Forehead Flap for Nasal Reconstruction: An Effective Modification to the Paramedian Forehead Flap
David A Shaye1, Rui Han Liu1, Jennifer Shehan2
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Background:
Patients undergoing nasal reconstruction with the paramedian forehead flap (PMFF) can lead to scalp hair transfer and brow distortion. To minimize this, we have adopted the low median forehead flap (LMFF).
Objectives:
To compare the hypothetical flap reach of the LMFF with the PMFF and measure flap viability and hair transfer amongst patients undergoing nasal reconstruction.
Materials And Methods:
A multi-institutional retrospective chart review of patients undergoing the LMFF collected demographics, flap viability, brow distortion, and hair transfer. Photograph measurements compared the hypothetic flap reach between an LMFF or PMFF design.
Results:
Eighty patients (mean age 65 ± 13 [SD] years, 56.3% female) met inclusion after LMFF for nasal defects, mostly from skin cancer resection (93.8%) involving the tip (67.1%) and ala (73.4%); with ≥3 involved subunits (63.8%). Transferred scalp hair (n = 1, 1.3%), and no flap compromise occurred. In photograph analysis, the LMFF showed an 11.6% increase in flap reach as compared to the PMFF (p < 0.0001). Intra-rater and inter-rater variances were nonsignificant.
Conclusions:
The LMFF is a viable modification to the PMFF for nasal reconstruction, especially in patients with short hairline and/or distal nasal tip/alar defects where increased flap reach and minimal hair transfer are desired.
