Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps.
Publication/Presentation Date
6-1-2025
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.
Volume
172
Issue
6
First Page
1888
Last Page
1896
ISSN
1097-6817
Published In/Presented At
Palmer, W. J., Amin, D., Kaki, P., Davis, M., Fei, E., Garg, N., Campbell, D. J., Michlin, D., Arianpour, K., Krein, H., & Heffelfinger, R. (2025). Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 172(6), 1888–1896. https://doi.org/10.1002/ohn.1210
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40062609
Department(s)
Administration and Leadership
Document Type
Article