Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps
- PMID: 40062609
- PMCID: PMC12120034
- DOI: 10.1002/ohn.1210
Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps
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.
© 2025 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.
Conflict of interest statement
None.
References
-
- Zito PM, Hohman MH, Mazzoni T. Paramedian forehead flaps. StatPearls. StatPearls Publishing; 2024. - PubMed
-
- Menick FJ. A 10‐year experience in nasal reconstruction with the three‐stage forehead flap. Plast Reconstr Surg. 2002;109(6):1839‐1855. - PubMed
-
- Santos Stahl A, Gubisch W, Fischer H, Haack S, Meisner C, Stahl S. A cohort study of paramedian forehead flap in 2 stages (87 flaps) and 3 stages (100 flaps). Ann Plast Surg. 2015;75(6):615‐619. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical