Extended Forehead Skin Expansion and Single-Stage Nasal Subunit Plasty for Nasal Reconstruction

Forehead skin is often insufficient to use for nasal reconstruction because of a low hairline. In addition, skin graft used to repair donor-site defects results in obvious mismatched patches, whereas healing by secondary intention of donor-site defects causes conspicuous scars. To make up for the shortage of forehead skin used for nasal reconstruction and primary donor-site defect closure, the authors challenged the conventional idea of late shrinkage of expanded forehead flaps for nasal construction, and suggest a technique combining extended forehead skin expansion with single-stage nasal subunit plasty. This technique was applied to 43 patients for nasal reconstruction over a 9-year period. The technique consists of three stages: extended forehead skin expansion, single-stage nasal contouring and subunit plasty, and pedicle restoration. All cases were followed for at least 12 months. Outcomes were evaluated in terms of aesthetics, function, and donor-site aesthetics. No secondary shrinkage occurred in any of the cases. Eighty-one percent of the patients assessed themselves as satisfactory for aesthetics, 70 percent assessed themselves as satisfactory for function, and 77 percent assessed themselves as satisfactory for donor-site aesthetics. The complications included minor brow elevation (five cases), L-strut distortion (four cases), stuffiness of the nostrils (four cases), flap hyperpigmentation (one case), flap skin paleness (one case), and alar graft extrusion (one case). The combination of extended forehead skin expansion with single-stage nasal subunit plasty overcomes the defect of late shrinkage of an expanded flap for nasal reconstruction and achieved satisfactory results in aesthetics (nose and donor site) and function.