Reconstruction of 2 Independent Facial Defects Using A Single Paramedian Forehead Flap.

[BACKGROUND] The paramedian forehead flap (PMFF) has been well established for use in reconstruction limited to a single nasal outer layer defect and has recently gained recognition as an acceptable alternative to traditional methods of lower eyelid reconstruction. The use of a single, pedicled PMFF for the reconstruction of more than one defect has yet to be described.

[METHODS] A 59-year-old male patient was originally diagnosed with large squamous cell carcinoma resulting in radical resection and ipsilateral neck dissection. Postoperative final pathology was read as basal cell carcinoma; due to close margins, the patient required adjuvant radiation therapy. Immediate reconstruction at index surgery included radial forearm free flap; however, the patient subsequently developed left eye symptoms due to lid retraction and nasal symptoms with a left alar defect. The authors report the use of a single pedicled PMFF to reconstruct 2 distinct ipsilateral defects in a radiated patient-nasal ala and lower eyelid.

[RESULTS] At 6 months post-secondary reconstruction, both recipient sites of the single PMFF appear viable and in adequate position without contraction. The patient has persistent but much improved symptoms related to his eye and nasal defects.

[CONCLUSION] A single PMFF can be safely and effectively used in the reconstruction of 2 distinct facial defects in the appropriate patient.