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Case Report Plastic and Aesthetic Research

Preliminary stages before nasal

reconstruction using forehead flap: restoring

perinasal subunits and nostril patency

Victor Diniz de Pochat , Fernando César Câmara de Oliveira , Felipe Simões da Rocha
1
1
Mata , Marcelo Sacramento Cunha , Nivaldo Alonso , José Valber Lima Meneses 1
1
2
1
1 Division of Plastic Surgery, Federal University of Bahia, Salvador, Bahia 40110, Brazil.
2 Division of Plastic Surgery, University of São Paulo, São Paulo 14040, Brazil.
Address for correspondence: Dr. Victor Diniz de Pochat, Division of Plastic Surgery, University Hospital Professor Edgard Santos, Federal
University of Bahia, Salvador, Bahia 40110, Brazil. E-mail: victor.pochat@gmail.com
ABSTRACT
Due to the complex three-dimensional structure of the nose, the repair of the nasal defect requires
reconstruction of three different layers: skin envelope, osteocartilaginous framework and nasal lining.
Before nasal reconstruction can be accomplished, the nose must rest on a stable platform to avoid
late nasal obstructions, and septal deviations resulting from scar contraction. We present three cases
of nasal reconstruction using a forehead flap in which we performed a preliminary stage to increase
reliability of outcomes.
Key words:
Forehead flap, nasal reconstruction, nostril stenosis, preliminary stages

INTRODUCTION therefore, may not reflect the true defect at the time of
presentation. [5]
Reconstruction of the nose is complex, due to its three The nose rests on a platform consisting of the premaxilla
dimensionality, and its prominence in the central facial and the piriform aperture surrounded by the adjacent soft
region. [1,2] Full thickness nasal defects require repair of tissues (upper lip and cheek) with a well‑defined angle
three different layers: skin envelope, osteocartilaginous and location. Improper positioning of nasal structures,
framework and nasal lining. The latter one is considered even for a few millimeters can generate significant
the most challenging. [3,4]
distortions. If such a platform is unstable, it can displace
Often, nasal defects extend into adjacent regions of the the reconstructed alar region inferiorly or laterally
face such as the lips and cheeks, increasing the complexity over time. Preliminary procedures, such as the repair
of wound reconstruction. One can choose to simply “fill of the lip and cheek defects using local flaps and skin
the hole”; however, when planning nasal reconstruction, grafts flap are usually necessary to prevent distortions
the surgeon should be aware that the defect may not and scar contracture of the adjacent nose before nasal
reflect the actual tissue loss. Swelling, infiltration of reconstruction. [6,7]
anesthesia, the action of gravity on tissues and scar
retraction may alter the dimensions of the defect; and There is limited information about preliminary stages
before paramedian forehead flap discussed in the
literature. The aim of this study is to demonstrate the
Access this article online
experience of the Rhinology team of the Plastic Surgery
Quick Response Code: Department (HUPES‑UFBA) using a preliminary stage to
Website:
www.parjournal.net stabilize the nasal platform before nasal reconstruction
using the paramedian forehead flap.
DOI: Between May 2011 and May 2013, the department
10.4103/2347-9264.149377 of Plastic Surgery, HUPES‑UFBA, performed 12 nasal
reconstruction surgeries that required paramedian

34 Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015