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Semin Plast Surg 2024; 38(04): 297-303
DOI: 10.1055/s-0044-1791564
Review Article

Complex Nasal Reconstruction: A Methodical Approach to the Three-Stage Paramedian Forehead Flap

Lauren McAllister
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
James Thornton
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract

Complex nasal reconstructions require adequate planning with an accurate estimation of the time necessary to perform each stage. Reconstructions of the entire nose, multiple subunits, or a substantial subunit typically require lining replacement and cartilage grafting. Securing the lining prior to a staged reconstruction is preferred, but options such as the Menick folded paramedian forehead flap (PMFF) allow for lining coverage at the time of the first stage. The free radial forearm flap and the PMFF remain the gold standard for the initial lining coverage. Cartilage grafting is fundamental to complex nasal reconstructions and can be secured in either the first or the second stage. Staged reconstructions require thorough patient education, patience from both the patient and the surgeon, and an understanding that final revisions may be necessary.

Keywords

complex nasal reconstruction - total nose reconstruction - subtotal reconstruction - paramedian forehead flap - Menick folded paramedian forehead flap - free radial forearm flap - nasal lining replacement - cartilage grafting


Publication History

Article published online:
04 November 2024

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