Paramedian Forehead Flap Nasal Reconstruction Surgical Technique

Cervenka, Brian; Tollefson, Travis; Pipkorn, Patrik

Paramedian Forehead Flap Nasal Reconstruction Surgical Technique

Open Education Resource

2025-10-31

Abstract

The paramedian forehead flap is a versatile pedicled flap based on the supratrochlear artery and is commonly used for nasal reconstruction. First described in 700 BC in ancient Indian literature by Sushruta Samita to reconstruct nasal defects from punitive tip amputation, it has subsequently become a workhorse of nasal reconstruction requireing more than 2cm soft tissue replacement on the external and internal nose. The paramedian forehead flap is simple to harvest, causes minimal donor site deformity, provides a large amount of skin and subcutaneous tissue that can be used for coplete external and internal nasal defects, and has a robust vascular supply allowing successful flap inset even when perichondrium or periosteum of the recipient site has been removed or there is poor vascular supply. Drawbacks include that it is a 2-stage procedure, and transfer of hair bearing tissue in patients with a low-lying hairline to the external nose.