The Single-Stage Paramedian Forehead Flap.

Abstract

The paramedian forehead flap, described by Millard in 1974,1 was proposed as an alternative to the axial median forehead flap, which had been used for several decades for the reconstruction of large defects of the tip, dorsum, and ala of the nose. The paramedian forehead flap is an excellent alternative for reconstruction of these areas of the nose, as it provides a large volume of cutaneous tissue with good viability.2 Traditionally, this flap has been performed in a 2-stage procedure, sectioning the dissected pedicle 3 weeks after the initial operation,3 although performing this technique in 3 stages has been studied for large defects, finding no differences in the necrosis rates.4 One of the drawbacks of this flap is the need to perform delayed reconstruction, with a significant increase in surgical costs and in patient discomfort. To avoid the disadvantages associated with the traditional technique, and following the modification put forward in 2002 by Park,5 we propose performing a paramedian forehead flap in a single operation, with a buried pedicle passing along the dorsum of the nose.