Retrospective case series of two-stage folded paramedian forehead flap nasal reconstruction without cartilage grafts

Full-thickness nasal defects of the tip, soft triangle, and ala are commonly reconstructed using a paramedian forehead flap with cartilage grafts or an epithesis. However, these approaches may be associated with donor-site morbidity and psychological burden. Cartilage grafts are generally considered necessary to prevent nostril collapse during inspiration. The aim of this study was to assess whether cartilage grafting is required to prevent nasal collapse and to evaluate patient satisfaction, complications, and functional and aesthetic outcomes.

This case series analysed postoperative outcomes in 10 patients following two-stage folded paramedian forehead flap reconstruction without cartilage grafts. Median follow-up was 14 months. Outcomes included patient satisfaction as well as functional and aesthetic results.

All patients reported being satisfied or very satisfied with their long-term postoperative outcomes. Nasal airflow on the reconstructed side was preserved without impairment. No cases of nostril collapse during inhalation were observed. Additionally, no hypertrophic scarring or tissue necrosis occurred.

Two-stage reconstruction of full-thickness nasal defects using a folded paramedian forehead flap without cartilage grafts provides good functional and aesthetic outcomes with high patient satisfaction. In most cases, additional cartilage grafting appears unnecessary.