title: Extended forehead skin expansion and single-stage nasal subunit plasty for nasal reconstruction.
abstract: BACKGROUND
  Forehead skin is often insufficient to use for nasal reconstruction because of a low hairline. In addition, skin graft used to repair donor-site defects results in obvious mismatched patches, whereas healing by secondary intention of donor-site defects causes conspicuous scars. To make up for the shortage of forehead skin used for nasal reconstruction and primary donor-site defect closure, the authors challenged the conventional idea of late shrinkage of expanded forehead flaps for nasal construction, and suggest a technique combining extended forehead skin expansion with single-stage nasal subunit plasty.
  
  
  METHODS
  This technique was applied to 43 patients for nasal reconstruction over a 9-year period. The technique consists of three stages: extended forehead skin expansion, single-stage nasal contouring and subunit plasty, and pedicle restoration. All cases were followed for at least 12 months. Outcomes were evaluated in terms of aesthetics, function, and donor-site aesthetics.
  
  
  RESULTS
  No secondary shrinkage occurred in any of the cases. Eighty-one percent of the patients assessed themselves as satisfactory for aesthetics, 70 percent assessed themselves as satisfactory for function, and 77 percent assessed themselves as satisfactory for donor-site aesthetics. The complications included minor brow elevation (five cases), L-strut distortion (four cases), stuffiness of the nostrils (four cases), flap hyperpigmentation (one case), flap skin paleness (one case), and alar graft extrusion (one case).
  
  
  CONCLUSIONS
  The combination of extended forehead skin expansion with single-stage nasal subunit plasty overcomes the defect of late shrinkage of an expanded flap for nasal reconstruction and achieved satisfactory results in aesthetics (nose and donor site) and function.
authors.affiliation: Shanghai, People's Republic of China From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine.
authors.forename: Rui
authors.initials: R
authors.lastname: Weng
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: Gu
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.forename: Guoxiong
authors.initials: G
authors.lastname: Shen
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D001733:Bites and Stings / Q000601:surgery; D002056:Burns / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000293:injuries / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*; D012867:Skin; D012880:Skin Pigmentation; D013524:Surgical Flaps; D015626:Tissue Expansion; D055815:Young Adult