Esthetic refinements in forehead flap nasal reconstruction.
OBJECTIVE
To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results.


METHODS
Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994.


METHODS
University hospital ambulatory surgery department.


METHODS
Thirty-two patients with various nasal defects.


METHODS
Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim.


METHODS
Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients.


RESULTS
Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (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 in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.
Quatela
V C
VC
Division of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, NY, USA.
Sherris
D A
DA
Rounds
M F
MF
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002280:Basal Cell Carcinoma / Q000601:surgery; D002356:Cartilage / Q000601:surgery; D003869:Dermabrasion; D004954:Esthetics; D005260:Female; D005546:Forehead / Q000601:surgery*; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000503:physiopathology / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D017060:Patient Satisfaction; D012086:Reoperation; D012119:Respiration; D012225:Rhinoplasty / Q000379:methods; D016038:Skin Transplantation / Q000379:methods* / Q000473:pathology; D013524:Surgical Flaps / Q000379:methods* / Q000473:pathology; D015626:Tissue Expansion; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D014222:Triamcinolone Acetonide