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forehead flaps. Of these, 3 patients required preliminary Case 2
procedures to stabilize the nasal platform. A 26‑year‑old female, presented with a total loss of
The selected cases were reported, highlighting the the left ala and upper lip retraction after a motorcycle
indication and the technique used in the reconstruction accident 4 years prior [Figure 3]. A preliminary stage
in the donor area of the flap as well as in the nasal and was indicated, and a Z‑plasty with a full thickness skin
perinasal region. The patients involved in this article agreed graft was performed in order to fill the resulting gap.
to publish their facial pictures and signed the consent form. Furthermore, a nostril enlargement was performed using
local flaps, and a tissue expander was placed in the
CASE REPORT forehead [Figure 4]. After 3 months, the expander was
removed, and a paramedian forehead flap was transferred
Case 1
A 29‑year‑old man presented with a nasal deformity in two stages [Figure 5]. In addition, part of the left
nostril scar was used as a hinge‑over flap to resurface
caused by paracoccidioidomycosis, which affected the
right ala leading to the nostril stenosis. In a preliminary the missing nasal lining. The cartilaginous framework was
stage, the right nostril was opened with a Z‑plasty and rebuilt using a conchal graft.
skin grafting was performed [Figure 1]. After 4 months, Case 3
he underwent resection of the scarred area to construct A 26‑year‑old man was referred to our department after
the original defect using a three stage paramedian an unsuccessful attempt at nasal reconstruction using a
folded forehead flaps to resurface the lining and nasal nasolabial flap. He sustained a gunshot trauma 8 years
subunits [Figure 2]. The cartilaginous support was prior to presentation. In the preliminary stage, a costal
achieved by a conchal cartilage graft performed in the cartilage graft was used for nasal dorsum augmentation.
second stage. An advanced V‑Y nasolabial flap was performed using
the previous scar to fill the nasal base lining and a full
thickness skin graft was placed to resurface nasal lining
and unblock the left nostril. Three months later a three
stage folded paramedian forehead flap was performed.
In this case, a new forehead flap was required to allow
better projection and support for the tip and resurfacing
the columella [Figure 6].
a b

c d
a b
Figure 1: Case 1. Right ala destruction and nostril stenosis. (a) Frontal
view, (b) oblique view, (c) preoperative landmark of aesthetic subunits, Figure 2: Case 1. One‑month after the three‑stage forehead flap.
(d) immediate postoperative correction of the stenosis with Z‑plasty and (a) Oblique view, (b) basal view
skin grafting

a b
a b

c d
c d
Figure 4: Case 2. Postoperative view after a preliminary stage including
Figure 3: Case 2. Preoperative: (a) frontal view, (b) close up of frontal expansion of the forehead, correction of retraction of the upper lip and
view showing upper lip retraction and deformity of left ala, (c) oblique left nostril opening. (a) Frontal view, (b) lateral view, (c) oblique view,
view, (d) basal view (d) frontal view with the landmarks
Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 35