Concomitant reconstruction of the nose and upper lip using an extensive paramedian frontal flap: A technical note

The paramedian forehead flap (PFF), based on the supratrochlear artery, is a ``gold standard'' for nasal reconstruction due to its robust vascularity and excellent color and texture match. However, its use for simultaneous reconstruction of both nose and upper lip following trauma or oncological resection has not been previously reported.

This technique aims to describe an extensive PFF incorporating both forehead and scalp tissues, enabling concomitant reconstruction of the nose and upper lip.

The procedure involves at least three stages. The first stage includes harvesting an extensive skin paddle with a scalp segment to reconstruct the hair-bearing upper lip. The second stage involves in initial flap weaning to release the lip and fold the flap for nasal reconstruction. The third stage consists of complete weaning of the nasal portion of the flap.

Two patients underwent this technique. Both achieved adequate tissue volume, with good color and texture match for the nose and a natural hair-bearing lip. Complications included partial flap necrosis in one case, and a delay in adjuvant radiotherapy was observed for the same patient.

Key challenges include minimizing infection risk and avoiding delays in adjuvant radiotherapy. While this innovative approach shows promise, further refinements such as strategic cartilage grafting and accelerated flap weaning, are required to optimize both functional and aesthetic outcomes.