title: Accelerated takedown of the paramedian forehead flap at 1 week: indications, technique, and improving patient quality of life.
abstract: BACKGROUND
  The paramedian forehead flap (PFF) is a common method of reconstruction for large nasal defects. Generally, surgeons divide this flap at 3 weeks. This delay can result in a significant decrease in the quality of life for these patients.
  
  
  OBJECTIVE
  We sought to describe the indications and technique for trunk division at 1 week after PFF reconstruction, and to evaluate the clinical outcomes.
  
  
  METHODS
  This was a case series of consecutive patients undergoing primarily nasal defect reconstruction by PFF repair during the past 6 years. We explored medical record review of associated complications, patient rating of impact on quality of life and final results of repair, and patient preferences regarding time to flap division.
  
  
  RESULTS
  A total of 26 patients underwent accelerated trunk division at a mean of 7.2 days. Of these, 27% had a history of tobacco use, 23% were diabetic, and 19% had cartilage grafts used in their repairs. None developed necrosis and other complications were minor. Most patients considered their trunk very disfiguring, preventing them from daily activities. This was especially true for those younger than 70 years. Of all patients, 94% preferred trunk division at 1 week, rather than 3 weeks.
  
  
  CONCLUSIONS
  Retrospective study design and number of patients were limitations.
  
  
  CONCLUSIONS
  PFF trunk division at 1 week is safe and effective for resurfacing of large nasal defects, including those reconstructions that require cartilage. Younger and healthier patients may be the most ideal candidates for accelerated division given the greater negative impact of an intact trunk on their lives.
authors.affiliation: Division of Dermatologic Surgery, Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Somoano
authors.forename: Jeremy
authors.initials: J
authors.lastname: Kampp
authors.forename: Hayes B
authors.initials: HB
authors.lastname: Gladstone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*