title: Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap.
abstract: BACKGROUND
  Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction.
  
  
  METHODS
  Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia.
  
  
  RESULTS
  Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary.
  
  
  CONCLUSIONS
  This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Florence, Faculty of Medicine and Surgery, Florence, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Raffaella
authors.initials: R
authors.lastname: Perello
authors.forename: Giulia Lo
authors.initials: GL
authors.lastname: Russo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
keywords: Nasal bone; Nasal surgical procedures; Nose deformities, acquired; Nose neoplasms; Surgical flaps