Nasal Aesthetic Restoration by Pre-expanded Paramedian Forehead Flap with Autologous Cartilage Framework and Laser...

As a prominent feature of the face, the nose is susceptible to a variety of traumatic or pathological defects. It is a challenge to restore the external nasal structures because of its delicate three-dimensional contours. For the defects involved in multiple subunits, the restoration procedures are difficult because of the requirements of sufficient skin cover, steady cartilage supporting and lining. In this study, the authors applied pre-expanded paramedian forehead flap combined with autologous cartilage framework and laser treatment to rebuild nasal structures and aesthetics.

A retrospective analysis was performed on nine patients who underwent nasal reconstructions and followed up between January 2020 and July 2024. The clinical data and surgical procedures were recorded and analyzed. The staged surgeries were included: tissue expander implantation, nasal reconstruction and pedicle division. The laser hair removal was applied postoperatively. The aesthetic outcomes were evaluated by FACE-Q questionnaires. The scars were scored by Vancouver Scar Scale.

A total of 9 patients (3 females and 6 males) were included, with a mean age of 28.33  ±  7.30 years. Seven flaps survived well without complication. Partial necrosis at the distal end of flap occurred in one case, and another case developed a postoperative wound infection. The scar quality was scored 2.78 ± 1.02 and 2.56 ± 0.88 in the donor and recipient sites by the Vancouver Scar Scale. The nasal appearance outcomes were scored 82.22 ± 6.65 by the Satisfaction With Nose Scale and 76.33 ± 11.30 by the Satisfaction With Nostrils. The donor sites of the forehead were scored 83.56 ± 5.46 by the Satisfaction With Forehead and Eyebrows.

The pre-expanded forehead flap combining with autologous cartilage is a feasible method for nasal reconstruction. The expansion technique and autologous costicartilage could provide adequate skin cover and reliable supporting to complete the nasal reconstruction with good outcomes. Postoperative laser and anti-scar treatments are beneficial for the appearance.

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