title: Alternative 1-step nasal reconstruction technique.
abstract: OBJECTIVE
  To describe a 1-step nasal reconstruction technique for use in lieu of a paramedian forehead flap that is usually raised at the location of the supratrochlear artery.
  
  
  METHODS
  Using angiography in 10 fresh cadavers, we confirmed the arterial anatomy of the nasal and forehead regions to refine the paramedian forehead flap. Based on the anatomical data, we performed nasal reconstruction in 6 patients who had a full-thickness defect of the nasal ala or who needed alar base reconstruction with an island paramedian forehead flap based on the angular artery.
  
  
  RESULTS
  From the anatomical study, we confirmed a rich network among the supratrochlear, dorsonasal, and angular arteries around the medial canthus. In the clinical cases, the subcutaneous pedicle was tunneled beneath the skin, without conspicuous bulkiness. For all patients, the operation was completed in 1 stage, and the flaps healed without evidence of necrosis.
  
  
  CONCLUSIONS
  By moving the pedicle downward, a full-thickness nasal defect can be reconstructed in 1 stage that includes the alar lining or alar base with the paramedian forehead flap. This avoids restriction of the rotation arc, particularly when the alar lining or alar base is also needed for reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. kkishi@sc.itc.keio.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kishi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Imanishi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Ruka
authors.initials: R
authors.lastname: Shimizu
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okabe
authors.forename: Hideo
authors.initials: H
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D002102:Cadaver; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead / Q000033:anatomy & histology* / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology