AESTHETIC REFINEMENTS IN FOREHEAD FLAP NASAL RECONSTRUCTION

Objective: To identify refinements in forehead flap nasal reconstructi on that consistently provide better esthetic and functional results. D esign: Case series of patients undergoing forehead flap nasal reconstr uction from July 1, 1987, to May 31, 1994. Setting: University hospita l ambulatory surgery department. Patients: Thirty-two patients with va rious nasal defects. Interventions: Modifications of currently accepte d techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehea d donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous recons truction of the the nasal tip and columella. The alar rim is reconstru cted with cartilage grafts placed at the nasal rim. Main Outcome Measu res: Esthetic and functional results of nasal reconstruction were subj ectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R. ) and the patients. Results: Improved esthetic and functional nasal re construction. The most common nasal subunits reconstructed were as fol lows: ala, 27 patients (84%); sidewall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results range d from average to excellent (3 to 5 on a scale of 5), the functional r esults ranged from improved to much improved over preoperative breathi ng (4 to 5). Two patients required unplanned surgical revisions. Forty -seven percent of patients chose to undergo dermabrasion. Five patient s required postoperative intradermal injection of triamcinolone aceton ide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. Conclusions: The predictability of the techniques in providing excellent results i n patients undergoing nasal reconstruction decreases the need for revi sion procedures and helps the patient and the surgeon achieve the desi red outcome.