Paramedian Frontal Flap Reconstruction for Nasal Defect Following an Accidental Amputation

Abstract

This case report aims to present the successful reconstruction of a nasal defect in a 56-year-old male patient who suffered a partial nasal amputation due to a domestic accident involving a grinding wheel. The reconstruction was carried out using a paramedian frontal flap in a two-stage surgical process. Initially, the flap was designed and customized to match the dimensions of the defect, with a pedicle width of approximately 1.5 cm vertically. The flap was elevated in a distal-to-proximal manner, starting with subcutaneous dissection and progressing to periosteal dissection proximally. Weekly dressing changes were made using fatty gauze and fusidic acid ointment. Four weeks postoperatively, the flap pedicle was divided, and the brow was repositioned. At the six-month follow-up, the patient showed satisfactory clinical outcomes with no functional complaints and was very pleased with the aesthetic result. Paramedian frontal flap reconstruction is a dependable technique for addressing nasal defects following traumatic amputation, providing favorable functional and aesthetic results. This case highlights the importance of careful surgical planning and technique in achieving successful facial reconstruction.

Keywords: facial reconstructive surgery; maxillo-facial trauma; nasal amputation; nasal reconstruction; paramedian frontal flap.

Figure 1. Initial images of the patient upon arrival at the emergency department

Figure 2. Stage 1 of the paramedian frontal flap procedure

Immediate postoperative image. Letters (A, A', B, B', C, C') illustrate the counterclockwise rotation of the paramedian frontal flap and the positioning of the sutures during this stage.

Figure 3. One week post-operation images, after suture removal

Figure 4. Four weeks post-operative images

Figure 5. Surgical planning of Stage 2 procedure

Pedicle sectioning with tissue repositioning for eyebrow elevation.

Figure 6. Stage 2 of the paramedian frontal flap procedure

Immediate postoperative period.

Figure 7. Results at six months post-operation