medigraphic.com
ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2026, Number 2

<< Back Next >>

Cir Plast 2026; 36 (2)

Forehead flap as a salvage alternative in complex nasal reconstruction: case report and brief literature review

Bautista-Fuentes C, Llamas-Ostos AN, Prieto-Vargas V, Nava-Márquez G, García-Córdova CE, Fuentes-Calvo KJ, Apellaniz-Campo AG

Language: Spanish
References: 22
Page: 184-188
PDF size: 1675.65 Kb.


ABSTRACT

Nasal reconstruction in patients with multiple prior surgeries represents a surgical challenge, especially when there are sequelae from extruded alloplastic implants and complex deformities. The paramedian forehead flap has become one of the main alternatives for extensive nasal defects due to its reliable vascularization, tissue similarity, and reconstructive versatility. We present the case of a 70-year-old patient with a history of five rhinoplasties following facial trauma, with silicone implant extrusion and severe nasal deformity. The patient reported breathing difficulty and significant aesthetic dissatisfaction. Surgical management included implant removal, placement of an L-shaped costal graft and coverage with a paramedian forehead flap. As the patient was from out of town, pedicle division was performed two months after the initial surgery. Postoperative evolution was satisfactory, with functional and aesthetic improvement. The forehead flap continues to be a first-line option in complex nasal reconstruction, since it allows three-dimensional restoration of the nasal pyramid, with adequate skin coverage and the possibility of integrating structural grafts. This case illustrates the effectiveness of the forehead flap as a salvage strategy in a patient with complex nasal defects, highlighting its historical and actual relevance in reconstructive surgery. The forehead flap is a safe and effective alternative after multiple failed surgeries, with satisfactory functional and aesthetic results.


REFERENCES

  1. Hope N, Young K, Mclaughlin K, Smyth C. Nasal trauma: Who nose what happens to the non-manipulated? Ulster Med J. 2021; 90 (1): 10-12.

  2. Tigga C, Kumar MS, Subhasish B, Siddartha M, Mohsina H. Rhinoplasty in secondary nasal deformities: Subjective and objective outcome evaluation. Natl J Maxillofac Surg. 2020; 11 (2): 186-192. doi: 10.4103/njms.NJMS_67_20.

  3. Hernández-Moreno ÁA, Manzo-Castrejón HA, Adame-Moreno RY. Colgajo frontonasal para la cobertura de defecto de punta nasal secundario a resección de carcinoma basocelular. Cir Plast. 2020; 30 (2): 133-136. doi: 10.35366/97678.

  4. Losco L, Bolletta A, Pierazzi DM, Spadoni D, Cuomo R, Marcasciano M et al. Reconstruction of the nose: Management of nasal cutaneous defects according to aesthetic subunit and defect size. Medicina (Kaunas). 2020; 56 (12): 639. doi: 10.3390/medicina56120639.

  5. Robalino D, Castro D, Cuenca L, Serrano A. Reconstrucción nasal con colgajo frontal paramediano: estudio retrospectivo. Cir Plast. 2020; 28 (2): 32-37.

  6. Arianpour K, Byrne PJ. Nasal lining reconstruction with prelaminated forehead flap. Facial Plast Surg Clin North Am. 2024; 32 (2): 239-246. doi: 10.1016/j.fsc.2024.02.001

  7. Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg. 1992; 118 (4): 373-379.

  8. Weng R, Li Q, Gu B, Liu K, Shen G, Xie F. Extended forehead skin expansion and single-stage nasal subunit plasty for nasal reconstruction. Plast Reconstr Surg. 2010; 125 (4): 1119-1128. doi: 10.1097/PRS.0b013e3181d0acb1.

  9. Ni HC, Wang JC, Sun JM, Guo NQ. Expanded forehead flap for nasal reconstruction. Plast Reconstr Surg. 2018; 141 (2): 307-315.

  10. Crosara PFTB, Nunes FB, Rodrigues DS, Figueiredo ARP, Becker HMG, Becker CG et al. Rhinoplasty complications and reoperations: systematic review. Int Arch Otorhinolaryngol. 2017; 21 (1): 97-101. doi: 10.1055/s-0036-1586489.

  11. Fijalkowska M, Antoszewski B. Classification of congenital nasal deformities: a proposal to amend the existing classification. Eur Arch Otorhinolaryngol. 2017; 274 (3): 1231-1235. doi: 10.1007/s00405-016-4195-y.

  12. Ghosh R, Gopalkrishnan K. Facial fractures. J Craniofac Surg. 2018; 29 (4): e334-e340. doi: 10.1097/SCS.0000000000004269.

  13. Fonseca RJ, Walker RV, Barber HD, Powers MP, Frost DE. Oral and maxillofacial trauma. 4th ed. Philadelphia: W.B. Saunders; 2013. p. 491.

  14. Shaye DA. The history of nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2021; 29 (4): 259-264. doi: 10.1097/MOO.0000000000000730.

  15. Abernathie BL, Granick M. Nasal reconstruction after basal cell excision. Eplasty. 2013; 13: ic10.

  16. Jena A, Gangasani R, Reddy NR, Patnayak R. Reconstruction with dorsal nasal flap after excision of basal cell carcinoma of the nose. J Cutan Aesthet Surg. 2017; 10 (1): 54-55. doi: 10.4103/JCAS.JCAS_128_15.

  17. Turan A, Kul Z, Türkaslan T, Ozyigit T, Ozsoy Z. Reconstruction of lower half defects of the nose with the lateral nasal artery pedicle nasolabial island flap. Plast Reconstr Surg. 2007; 119 (6): 1767-1772.

  18. Ozgur S, Eren H, Yildirim S, Uysal AC. Vascular considerations in nasal reconstruction with cartilage grafts. J Plast Reconstr Aesthet Surg. 2020; 73 (5): 851-858.

  19. Fisher M, Alba B, Ahmad J, Robotti E, Cerkes N, Gruber RP et al. Current practices in dorsal augmentation rhinoplasty. Plast Reconstr Surg. 2022; 149 (5): 1088-1102. doi: 10.1097/PRS.0000000000009057.

  20. Smith J, Allen R, Chen Y. Immune response to silicone implants in nasal reconstruction. J Biomed Mater Res B Appl Biomater. 2020; 108 (4): 1452-1459.

  21. Brown K, Smith T. Surgical strategies to reduce extrusion of nasal silicone implants. Ann Plast Surg. 2021; 86 (3): 310-315.

  22. García P, López R, Martínez J. Advances in biomaterials for nasal prosthesis: a systematic review. Plast Aesthet Res. 2023; 10: 15.




2020     |     www.medigraphic.com