Skip to main content
AAO-HNSF 2024 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back

Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentations 1 - Facial Plastic and Reconstructive Surgery

Outcomes and Complications of 2-Stage vs 3-Stage Paramedian Forehead Flaps

Sunday, September 29, 2024
1:24 PM – 1:30 PM EDT
Location: MBCC, 232
Disclosure(s):
Dev R. Amin, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matt Davis, BArch:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Praneet C. Kaki, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Eric Fei, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Neha Garg, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Howard D. Krein, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan N. Heffelfinger, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The paramedian forehead flap (PFF) is an essential tool in Mohs defect reconstruction. The aim of this study is to explore outcomes and complications among 2-stage PFFs, 3-stage PFFs, and PFFs undergoing accelerated pedicle takedown.

Methods: This is a retrospective cohort study of patients who underwent PFF for cutaneous defects between 2017 and 2022 at a single tertiary care institution. Functional and cosmetic outcomes and complications were evaluated. Demographic, clinical, and surgical characteristics were compared among groups.

Results: Among 79 patients analyzed, 61 patients underwent 2-stage PFF, and 18 patients underwent 3-stage PFF. In the 2-stage PFF group, 20 patients underwent accelerated pedicle takedown ( < 21 days). There were no significant differences in demographics, comorbidities, or surgical risk factors such as smoking and radiation therapy among groups. 3-stage PFF patients were more likely to have a cartilage defect (72%, 39%; p = 0.014) and an internal nasal defect (50%, 23%; p = 0.026). There were no differences in surgical complications (hematoma, infection, dehiscence, flap necrosis, fistula) or cosmetic complications (pincushioning, hypertrophic scarring, trapdoor deformity, alar notching, irregular pigmentation, edema) between the 2-stage and 3-stage PFF, including in a subanalysis of patients who required cartilage grafting. Additionally, the accelerated pedicle takedown group had no differences in surgical or cosmetic complications. Multivariate logistic regression identified internal nasal defect as a predictor of future revision procedures (OR 16.1, p = 0.024).

Conclusions: Both 2-stage and 3-stage PFF techniques are safe and effective tools in midface reconstruction, including when cartilage grafting is required. In the 2-stage PFF, accelerated pedicle takedown was not associated with increased surgical or cosmetic complications. Patients with internal nasal defects are more likely to require additional reconstructive or debulking procedures after PFF.

    Presenting Author(s)

  • Dev R. Amin, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Matt Davis, BArch

    Medical Student
    Sidney Kimmel Medical College, Thomas Jefferson University
    West Chester, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Praneet C. Kaki, BS

    Medical Student
    Sidney Kimmel Medical College, Thomas Jefferson University
    Kendall Park, New Jersey, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Eric Fei, BA

    Medical Student
    Sidney Kimmel Medical College, Thomas Jefferson University
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Neha Garg, BA

    Medical Student
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Howard D. Krein, MD, PhD

    Professor
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Ryan N. Heffelfinger, MD

    Professor, Department of OTO-HNS
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.