Brian Somoano1, Jeremy Kampp, Hayes B Gladstone. 1. Division of Dermatologic Surgery, Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.
Abstract
BACKGROUND: The paramedian forehead flap (PFF) is a common method of reconstruction for large nasal defects. Generally, surgeons divide this flap at 3 weeks. This delay can result in a significant decrease in the quality of life for these patients. OBJECTIVE: We sought to describe the indications and technique for trunk division at 1 week after PFF reconstruction, and to evaluate the clinical outcomes. METHODS: This was a case series of consecutive patients undergoing primarily nasal defect reconstruction by PFF repair during the past 6 years. We explored medical record review of associated complications, patient rating of impact on quality of life and final results of repair, and patient preferences regarding time to flap division. RESULTS: A total of 26 patients underwent accelerated trunk division at a mean of 7.2 days. Of these, 27% had a history of tobacco use, 23% were diabetic, and 19% had cartilage grafts used in their repairs. None developed necrosis and other complications were minor. Most patients considered their trunk very disfiguring, preventing them from daily activities. This was especially true for those younger than 70 years. Of all patients, 94% preferred trunk division at 1 week, rather than 3 weeks. LIMITATIONS: Retrospective study design and number of patients were limitations. CONCLUSION: PFF trunk division at 1 week is safe and effective for resurfacing of large nasal defects, including those reconstructions that require cartilage. Younger and healthier patients may be the most ideal candidates for accelerated division given the greater negative impact of an intact trunk on their lives.
BACKGROUND: The paramedian forehead flap (PFF) is a common method of reconstruction for large nasal defects. Generally, surgeons divide this flap at 3 weeks. This delay can result in a significant decrease in the quality of life for these patients. OBJECTIVE: We sought to describe the indications and technique for trunk division at 1 week after PFF reconstruction, and to evaluate the clinical outcomes. METHODS: This was a case series of consecutive patients undergoing primarily nasal defect reconstruction by PFF repair during the past 6 years. We explored medical record review of associated complications, patient rating of impact on quality of life and final results of repair, and patient preferences regarding time to flap division. RESULTS: A total of 26 patients underwent accelerated trunk division at a mean of 7.2 days. Of these, 27% had a history of tobacco use, 23% were diabetic, and 19% had cartilage grafts used in their repairs. None developed necrosis and other complications were minor. Most patients considered their trunk very disfiguring, preventing them from daily activities. This was especially true for those younger than 70 years. Of all patients, 94% preferred trunk division at 1 week, rather than 3 weeks. LIMITATIONS: Retrospective study design and number of patients were limitations. CONCLUSION: PFF trunk division at 1 week is safe and effective for resurfacing of large nasal defects, including those reconstructions that require cartilage. Younger and healthier patients may be the most ideal candidates for accelerated division given the greater negative impact of an intact trunk on their lives.
Authors: Garrett Ni; Rohan Brebion; Pablo A Baltodano; Michael C Coronado; Nicholas Elmer; Theresa K Webster; Huaqing Zhao; Xiaoning Lu; Sthefano Araya; Sameer Patel Journal: JPRAS Open Date: 2022-06-29