Pre-expanded Forehead Flaps for Nasal Reconstruction

Abstract

Introduction: Nasal reconstruction for extensive defects requires tissue of similar color, texture, and thickness. This review evaluates the paramedian forehead flap with pre-expansion for total or subtotal nasal reconstruction.

Methods: A systematic review of case series and cohort studies was performed. Inclusion: patients undergoing two-stage or three-stage forehead flap nasal reconstruction with prior tissue expansion. Outcomes: flap survival, aesthetic result, donor site morbidity, and need for revision.

Results: Seventeen studies (n=231 patients) were included. Flap survival exceeded 95%. Pre-expansion allowed primary donor site closure in 90% of cases. Aesthetic results, rated by independent observers, were good to excellent in 85%. Revision procedures (mostly debulking) were required in 40% of patients. Donor site scars were well-accepted.

Discussion: Pre-expansion increases available tissue and reduces donor site deformity. The main limitation is the two-stage expansion process requiring patient compliance. Thicker flaps may necessitate debulking.

Conclusions: Pre-expanded forehead flaps are a reliable method for complex nasal reconstruction, offering excellent color match. Patient selection and staged planning are critical for success.