Staged Paramedian Forehead Flap for Nasal Reconstruction Following Oncological Excision: A Two-Case Series

Abstract

Background: Reconstruction of nasal defects following oncological excision requires restoration of tissue coverage while preserving facial contour and minimising functional and aesthetic deformity. The paramedian forehead flap provides tissue with characteristics suitable for reconstruction of substantial nasal defects. Case Presentation: Two patients with malignant tumours of the nasal tip underwent oncological excision followed by staged reconstruction using a paramedian forehead flap. The first patient was a 75-year-old woman whose initial biopsy suggested basal cell carcinoma; definitive histopathological examination demonstrated trichilemmal carcinoma with clear lateral and deep margins. The resulting defect measured 2.5 × 2 cm, and reconstruction was performed 15 days after excision. The second patient was a 72-year-old man with an infiltrating basal cell carcinoma. Excision produced a 2.8 × 2 cm defect with histologically clear margins, and flap reconstruction was performed 23 days later. Pedicle division was performed as a second surgical stage, 33 days after flap coverage in the first patient and 21 days after coverage in the second. Nasal conformers were used in both patients to reduce the risk of alar retraction. No flap necrosis, vascular compromise, infection, or wound dehiscence was reported. Aesthetic outcomes were considered satisfactory, and no clinical evidence suggestive of tumour recurrence was observed during the reported initial one-year follow-up. Conclusion: These two cases illustrate the practical use of the paramedian forehead flap for reconstruction of substantial nasal defects after histological confirmation of tumour clearance.