title: Refinements in nasal reconstruction: the cross-paramedian forehead flap.
abstract: BACKGROUND
  Nasal reconstruction can be a challenge for the plastic surgeon. The forehead flap is the workhorse in nasal reconstruction, providing similar skin color, texture, structure, and reliability. There are disadvantages of the forehead flap, including a difficult arc of rotation, which risks displacement of medial eyebrow hair. The vertical design can encroach on the scalp, incorporating hair into the nasal reconstruction. Forehead flap inset results in an inverted V-shaped scar visible in the glabella region. This article describes the authors' modification of the established oblique paramedian forehead flap.
  
  
  METHODS
  This retrospective study included a consecutive series of patients over an 11-year period (December of 1996 to December of 2007) that underwent nasal reconstruction performed by the primary surgeon (J.A.). Information obtained from chart reviews included age, sex, cause of nasal defect, complications, and revisions.
  
  
  RESULTS
  This study population consisted of 94 adults: 54 men (57 percent) and 40 women (43 percent) who underwent nasal reconstruction using the cross-paramedian forehead flap. All flaps were performed for skin cancer reconstruction. Partial flap loss was the most common complication. Tobacco use was associated with half of the complications. Further refinements following forehead flap inset were performed in 50 percent of patients.
  
  
  CONCLUSIONS
  The cross-paramedian forehead flap is a useful design when planning subtotal nasal reconstruction. It provides a smooth arc of rotation and increased length, avoids an inverted V-shaped glabella scar, and minimizes eyebrow distortion. These modifications of the forehead flap maintain the reliability and versatility of the flap and provide an aesthetically pleasing result.
authors.affiliation: Winston-Salem, N.C. From the Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine.
authors.forename: Jeff
authors.initials: J
authors.lastname: Angobaldo
authors.forename: Malcolm
authors.initials: M
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005546:Forehead; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012225:Rhinoplasty / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D014029:Tobacco Use Disorder / Q000150:complications / Q000453:epidemiology