Modified Para-Median Forehead Flap Reconstruction for Nasal Defects
Modified Para-Median Forehead Flap Reconstruction for Nasal Defects
Ibrahim A Ashary, MD *, Mawada Nagm, BDS
Corresponding Author: Ibrahim A Ashary, MD, Consultant plastic surgery and laser specialist,
Saudi Arabia.
Copy Right: © 2022 Ibrahim A Ashary, MD, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: April 26, 2022
Published Date: May 01, 2022
Abstract:
Background:
Nasal reconstruction has been one of the most challenging procedures in reconstructive plastic surgery, the modern-day forehead flap has developed as a result of improvements in technique.
Material and Methods:
We selected a case report from one of the patients admitted in our clinic 2021, who came presented with extensive columellar defect that resulted from previous rhinoplasty, which presented a great candidate for paramedian forehead flap reconstruction.
Conclusion:
We used a flap that was only supported by the left supratrocheal artery, allowing us to rotate the flap without distorting the vessels.
In such cases, the modified paramedian flap is still the safest aesthetically and functionally for the patient, to achieve good coverage with the smallest donor site defect possible.
Modified Para-Median Forehead Flap Reconstruction for Nasal Defects
Introduction
Nasal reconstruction has been one of the most challenging procedures in reconstructive plastic surgery. Minor nasal defects may be sutured closed or covered with small local flaps or skin grafts. However, in the case of large nasal defects, a greater source of color and texture matching tissue is needed to ensure functional and aesthetic outcomes.1
Therefore, the paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects.2
Sushruta Samita presented the first nasal reconstruction using forehead flaps in 600 B.C. Specialists have known since ancient times that the forehead is an ideal donor site for nasal defects, with a strong color and texture match. 3
Because of its vascular support, it is extremely versatile. The paramedian forehead flap is an axial flap on the medial side of the eyebrow that is centered on a single supratrochelar/supraorbital artery and is centered on the supraorbital or supratrochlear arteries. A central broad pedicle with both supratrochelar vessels is used in the conventional median forehead flap procedure.4
For a variety of reasons, preoperative evaluation is extremely crucial in forehead flaps. There are two types of evaluations. The first is to determine if the flap is feasible for the specific patient. The second group involves determining what needs to be accomplished in order to successfully correct the defect. What donor resources are available to aid in the reconstruction, and what are the drawbacks of the donor tissues.5
Case Report
A 27 years old female came to our clinic presented with a total columellar defect after undergoing 7 rhinoplasties in several different clinics.
In order to mark the flap the Doppler device was used to locate the arterial supply.
After marking the flap the patient underwent general anesthesia and then was locally anesthetized in the areas of incision.
The incision was done using a blade (15) in the forehead to harvest the paramedial flap from the left side that is supported by the supratrocheal artery, then an endo-nasal incision and pointed scissors for subperiendocondrical dissection was done to obtain a path for the graft from inside the nose, this modification has several advantages:
- Huge improvement in the psychological well-being of the patient due to the invisibility of the flap.
- The flap guided internally was functioning aesthetically as a bridge for the nose.
Epithelialization of the flap to be placed inside the nose as a septal graft.
After the graft was placed at the base of the medial crus it was sutured with 5.0 vicryl and the frontal skin was closed with 3.0 vicryl and 5.0 vicry and dressed with sterile strips.
Conclusion
We used a flap that was only supported by the supratrocheal artery, allowing us to rotate the flap without distorting the vessels.
In these cases, the modified paramedian flap is the safest aesthetically and functionally for the patient, to achieve good coverage with the smallest donor site defect possible.
References
3. Menick FJ. Mosby/Elsevier; New York: 2009. Nasal Reconstruction Art and Practice.
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