Repurposing the PMFF Pedicle Before Final Division: Distal Necrosis Salvage With Long-Term Success

A woman in her 60s developed early venous congestion and distal necrosis following paramedian forehead flap reconstruction of a left alar Mohs defect. The viable proximal PMFF pedicle was repurposed to reconstruct the compromised alar subunit, providing a tissue-sparing salvage technique that avoided a contralateral forehead flap or additional regional donor site. Long-term follow-up demonstrated durable flap viability, preserved nasal airway patency, and favorable alar contour and color match.