Folded Paramedian Forehead Flap Effective for Full-Thickness Nasal Reconstruction: Study

A new study published in the Journal of the German Society of Dermatology found that two-stage reconstruction of full-thickness nasal defects using a folded paramedian forehead flap without cartilage grafts achieved good functional and aesthetic outcomes with high patient satisfaction, suggesting that additional cartilage grafting is unnecessary in most cases.

Full-thickness defects of the nose which involves the nasal tip, soft triangle, and ala, are among the most complex facial reconstructive challenges. Surgeons have relied on paramedian forehead flaps combined with cartilage grafts or prosthetic epitheses to rebuild these areas. Cartilage grafts are typically harvested from the ear or rib and are believed to be essential for maintaining nostril stability and preventing collapse during breathing. 

The folded paramedian forehead flap technique itself is already regarded as a reliable method because of its excellent blood supply and close match in skin texture and color. By avoiding cartilage grafts, surgeons may be able to simplify procedures while still preserving natural nasal contour and respiratory function. The latest findings indicate that the additional grafting procedure may not be required in many cases.

The study followed 10 patients who underwent reconstruction using a folded paramedian forehead flap without cartilage support. This research monitored outcomes over a median follow-up period of 14 months, which evaluated patient satisfaction, breathing function, cosmetic appearance, and postoperative complications.

All the patients reported being either satisfied or very satisfied with their long-term outcomes. Also, none of the participants experienced nostril collapse during inhalation. Nasal airflow remained normal on the reconstructed side, suggesting that just the folded flap provided adequate structural support.

None of the patients developed hypertrophic scarring, tissue necrosis, or other major complications during recovery. This study observed that eliminating cartilage graft harvesting could reduce donor-site morbidity, shorten surgical complexity, and lessen the psychological burden often associated with multiple operative sites.

Overall, these results suggest that two-stage folded forehead flap reconstruction without cartilage grafting offers good functional and aesthetic outcomes with high patient satisfaction. The findings could pave the way for more streamlined nasal reconstruction protocols and improved quality of life for patients recovering from trauma, cancer surgery, or congenital nasal defects.

Source:

Hempel, C., Schnabel, V., Simon, J.-C., & Grunewald, S. (2026). Retrospective case series of two-stage folded paramedian forehead flap nasal reconstruction without cartilage grafts. Journal Der Deutschen Dermatologischen Gesellschaft [Journal of the German Society of Dermatology], ddg.70389. https://doi.org/10.1111/ddg.70389