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Comparative Study
. 2025 Jun;172(6):1888-1896.
doi: 10.1002/ohn.1210. Epub 2025 Mar 10.

Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps

W Jack Palmer  1 , Dev Amin  1 , Praneet Kaki  2 , Matt Davis  2 , Eric Fei  2 , Neha Garg  1 , Daniel J Campbell  1 , Dana Michlin  1   2 , Khashayar Arianpour  1 , Howard Krein  1 , Ryan Heffelfinger  1
Affiliations
Comparative Study

Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps

W Jack Palmer et al. Otolaryngol Head Neck Surg. 2025 Jun.

Abstract

Objective: This study aims to explore outcomes among 2-stage paramedian forehead flaps (PFFs), 3-stage PFFs, and PFFs undergoing accelerated pedicle takedown.

Study design: A retrospective review.

Setting: A tertiary care institution.

Methods: Patients who underwent PFFs for nasal defects between 2017 and 2022 were identified. Demographic, clinical, and surgical characteristics were compared among groups. Surgical and cosmetic outcomes and revision procedures were evaluated.

Results: Among 52 patients analyzed, 39 underwent 2-stage PFFs, and 13 underwent 3-stage PFFs. There were no significant differences in demographics, comorbidities, or surgical risk factors between groups. Three-stage PFF patients were more likely to have a cartilaginous defect. Postoperative dyspigmentation was seen more frequently in the 3-stage group; otherwise, there were no significant differences in outcomes. In a subanalysis of 29 patients requiring cartilage grafting, dyspigmentation was again seen more commonly in the 3-stage group; outcomes otherwise did not favor either group. Within the 2-stage group, 7 patients underwent accelerated pedicle takedown (≤21 days). No failures were seen with accelerated takedown, including among those who also received cartilage grafting. Overall, accelerated takedown was not associated with poorer surgical or cosmetic outcomes or an increased revision rate compared to standard takedown. Logistic regression did not identify any independent predictors of complication.

Conclusion: Both 2- and 3-stage PFFs are effective tools in midface reconstruction, including when cartilage grafting is required. With 2-stage PFF, accelerated pedicle takedown is not associated with increased complications in appropriately selected patients.

Keywords: Mohs reconstruction; facial reconstruction; forehead flap; regional flaps; skin cancer.

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Conflict of interest statement

None.

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