Alternative 1-Step Nasal Reconstruction Technique

JAMA Facial Plastic Surgery, 03/23/2012

By moving the pedicle downward, a full–thickness nasal defect can be reconstructed in 1 stage that includes the alar lining or alar base with the paramedian forehead flap. This avoids restriction of the rotation arc, particularly when the alar lining or alar base is also needed for reconstruction.


  • Using angiography in 10, authors confirmed the arterial anatomy of the nasal and forehead regions to refine the paramedian forehead flap.
  • Based on the anatomical data, they performed nasal reconstruction in 6 patients who had a full–thickness defect of the nasal ala or who needed alar base reconstruction with an island paramedian forehead flap based on the angular artery.


  • From the anatomical study, they confirmed a rich network among the supratrochlear, dorsonasal, and angular arteries around the medial canthus.
  • In the clinical cases, the subcutaneous pedicle was tunneled beneath the skin, without conspicuous bulkiness.
  • For all patients, the operation was completed in 1 stage, and the flaps healed without evidence of necrosis.

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