Double Horizontal Semicircular 1-stage Island Forehead Flap for Nasal Reconstruction in an Older Patient

A conventional paramedian forehead flap-a reliable option for nasal reconstruction-typically requires multiple stages and often results in a vertically oriented donor-site scar that crosses the natural forehead rhytids. Although single-stage island forehead flaps have been introduced to reduce the treatment burden, concerns remain regarding aesthetic outcomes and flap perfusion stability. Herein, we report a successful case of nasal reconstruction using a modified 1-stage island forehead flap with a double horizontal semicircular design. An 89-year-old woman presented with a squamous cell carcinoma of the nasal dorsum. The patient lived with her husband, who required nursing care, and requested a treatment plan that minimized time away from home. Following tumor excision, 1-stage reconstruction was performed using a horizontally oriented double horizontal semicircular island forehead flap. A musculocutaneous island flap with a buried frontal muscle pedicle in the supratrochlear artery was elevated. The flap was transferred through a subcutaneous tunnel and folded to cover the nasal dorsal defect. The donor site was closed primarily along the horizontal rhytids. Postoperatively, mild transient venous congestion was observed, which resolved spontaneously. Minor secondary revisions, including flap defatting and medial brow lifts, were performed on an outpatient basis. At the 1-year follow-up, the patient demonstrated excellent aesthetic outcomes with a well-camouflaged donor-site scar. This modified 1-stage island forehead flap presented a balanced reconstruction approach that can achieve favorable cosmetic results, flap reliability, and early social reintegration. This technique is particularly suitable for older patients with horizontal forehead rhytids who prefer single-stage reconstructions.