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Three-stage forehead flap with modified folded lining addresses anatomical deficits

Article-Three-stage forehead flap with modified folded lining addresses anatomical deficits

Key iconKey Points

  • Full-thickness forehead flap procedure with modification of traditional technique for the nasal lining with delayed primary graft replacement allows safe, reliable method for restoring form and function
  • Modified technique provides equal or better results in a procedure that is technically easier for surgeon and less traumatic for patient, expert says

Dr. Menick
TUCSON, ARIZ. — A full-thickness forehead flap procedure incorporating a modification of the traditional folded forehead flap technique for the nasal lining with delayed primary graft replacement offers a safe and reliable method for successfully restoring form and function in patients with a major defect of the nose, says Frederick J. Menick, M.D.

Currently, Dr. Menick relies on this approach as his workhorse for the majority of patients who present for the repair of full-thickness nasal defects. Exceptions are those patients with a very large defect where a free flap is needed, as in an individual with irradiation injury or extreme cocaine abuse.

While this approach employs a three-stage operation that takes two months to complete, Dr. Menick says he believes it provides better cosmetic and functional results compared with traditional methods, which are less reliable or more destructive to the remaining nose.

"Based on color and texture, forehead skin is the best donor tissue to resurface the nose, and it is best transferred as a full-thickness flap, especially when repairing defects that extend through the full thickness of the nose," says Dr. Menick, a board-certified plastic surgeon in private practice in Tucson, Ariz., and clinical associate professor of surgery, University of Arizona College of Medicine. "Taking a little extra skin for folding provides a simple and effective way to restore a thin, supple, vascularized nasal lining."

"Achieving the goals of restoring both form and function in the reconstruction of complex nasal defects requires a multistage procedure, and in my experience, patients are more than willing to delay pedicle division to achieve better functional and cosmetic results," he says. "In the end, these patients are happier than those left with a suboptimal outcome after a 'simpler' repair. The latter patients may not only be unhappy, but angry, as well, because of a poor result."

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