Complications with forehead flaps in nasal reconstruction.
OBJECTIVE
To determine what characteristics and comorbidities are associated with a higher rate of complications in patients undergoing nasal reconstruction with a forehead flap.


METHODS
Retrospective chart review.


METHODS
Chart review was completed on all patients undergoing nasal reconstruction with forehead flap from 1995 to 2008. Three pre-existing comorbidities were tracked: diabetes, smoking, and vascular disease. Major complications (flap necrosis, nasal obstruction, alar notching) and minor adverse outcomes (partial nasal obstruction, epidermolysis, and alar asymmetry) were recorded.


RESULTS
Two hundred five patients with a median age of 66 years had forehead flap reconstruction between October 1995 and July 2008. Sixty-two patients (30.2%) had full-thickness defects. Forty-eight patients (23.4%) were smokers, 17 (8.3%) were diabetics, and 90 (43.9%) fell into our category of vascular disease. Thirty-three (16.1%) developed a major complication at some point in their postoperative course, with 11 (5.4%) having some degree of flap necrosis, 10 (4.9%) nasal obstruction, and 20 (9.8%) alar notching. Full-thickness defects were significantly associated with higher incidences of any major complication, and had higher odds of flap necrosis and alar notching. Smokers had higher odds of developing flap necrosis. Neither the presence of diabetes, increased age, nor vascular disease was significantly associated with higher rates of major complications.


CONCLUSIONS
Smokers with full-thickness defects are shown to be at greater odds for developing a postoperative complication. Laryngoscope, 2009.
and Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia 22908-0713, USA.
Stewart C
SC
Little
Brian B
BB
Hughley
Stephen S
SS
Park
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery; D009336:Necrosis; D009669:Nose Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps; D055815:Young Adult