title: Aesthetic and Functional Outcomes of 2-Stage Versus 3-Stage Paramedian Forehead Flap Techniques: A 9-Year Comparative Study With Prospectively Collected Data.
abstract: BACKGROUND
  The 3-stage forehead flap technique has been described as an aesthetic improvement after nasal reconstruction compared with the 2-stage technique. A standardized evaluation of aesthetic and functional outcomes of the 2-stage versus 3-stage paramedian forehead flap after nasal reconstruction was performed.
  
  
  METHODS
  Between July 2003 and December 2012, 102 patients underwent either 2-stage or 3-stage paramedian forehead flap techniques. A standardized patient satisfaction questionnaire was used to assess resulting nasal appearance and function. Additionally, 2 plastic surgeons performed blinded assessments of the aesthetic outcome using a standardized photographic evaluation form. Together, these evaluations demonstrated functional and aesthetic outcomes (flap thickness, shape, color, flap hair growth, donor-site scars, and nasal symmetry).
  
  
  RESULTS
  Functional and aesthetic outcomes according to the self-assessment questionnaire were similar between groups. On inclusion of the surgeon's evaluation, with a greater satisfaction was apparent from the reconstructed alar of the 2-stage group (Mann-Whitney U test, p = .03, Fisher exact test, p = .024, respectively).
  
  
  CONCLUSIONS
  No clear evidence supported enhanced aesthetic results when the 3-stage forehead flap technique was used, especially in relation to flap thickness compared with the 2-stage technique. The 2-stage technique remains the state-of-the-art choice for nasal reconstruction, even in cases involving complex defects.
  
  
  METHODS
  Therapy, Level III, and retrospective comparative study with prospectively collected data.
authors.affiliation: *Department for Plastic Surgery, Marienhospital Stuttgart, Stuttgart, Germany; †Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University of Tübingen, Silcherstr, Tübingen, Germany; ‡Department of Plastic, Hand and Reconstructive Surgery and Burn Center of the BG-Trauma Center, Eberhard-Karl University, Schnarrenbergst, Tübingen, Germany.
authors.forename: Adelana S
authors.initials: AS
authors.lastname: Stahl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gubisch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haack
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.forename: Stéphane
authors.initials: S
authors.lastname: Stahl
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005546:Forehead; D006801:Humans; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D017060:Patient Satisfaction; D020127:Recovery of Function; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome