Outcomes of the Paramedian Forehead Flap for Nasal Reconstruction: Systematic Review and Meta-Analysis
In brief
Single-stage forehead flaps had 6% venous congestion, versus 0.5% with two-stage
Across 69 observational studies involving 4,100 patients, paramedian forehead flaps had high survival and generally infrequent complications. Venous congestion was more common after single-stage reconstruction than after two-stage or three-stage procedures, while flap survival did not differ by stage; cartilage grafting was associated with a 3.4 percentage point reduction in complete survival. These pooled findings can inform counseling, but do not establish that staging causes the difference.
- Journal
- The Laryngoscope (Q1)
- Published
- 28 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Renate Ma, Cali Loblundo, Shaun A Nguyen, Krishna G Patel, Michelle S Hwang
- PMID
- 42951365
- DOI
- 10.1002/lary.71018
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 31 October 2026): Systematic review quantifies nasal flap survival and complications
Abstract
OBJECTIVE(S): Paramedian forehead flap (PMFF) reconstruction remains the gold standard for complex nasal defects, yet outcomes have not been comprehensively synthesized. We aimed to define flap survival, complication profiles, and reconstructive patterns through the largest systematic review and meta-analysis of PMFFs to date. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and Scopus. REVIEW METHODS: Databases were searched from inception through June 2026. Observational studies of PMFFs for nasal reconstruction were included; non-English, non-human studies, and case series with ≤ 5 participants were excluded. Continuous measures, proportions, and proportional differences (Δ%) were meta-analyzed with 95% confidence intervals (CI). RESULTS: Across 69 studies (n = 4100), mean age was 59.3 years (95% CI: 54.6-64.0; range: 1-95), 54.3% were male, and mean follow-up was 19.8 months (95% CI: 15.2-24.3). Basal cell carcinoma was the most common indication (64.9%), followed by trauma (33.9%). Full-thickness defects comprised 55.3% of reconstructions. Two-stage reconstruction predominated (67.9%), followed by three-stage (18.7%) and single-stage approaches (5.6%). Complications were infrequent; scar retraction (6.6%), bleeding (6.2%), and venous congestion (6.1%) were most common. Flap survival did not differ by stage number, indication, or perforator localization. Venous congestion was more frequent after single-stage reconstruction (6.0%) versus two-stage (0.5%; Δ5.5%, 95% CI: 1.6%-15.1%; p < 0.0001) and three-stage procedures (1.2%; Δ4.9%, 95% CI: 0.6%-14.5%; p = 0.0146). Cartilage grafting reduced complete flap survival by 3.4% (95% CI: 0.04%-9.4%). CONCLUSION: This largest-to-date meta-analysis demonstrates that PMFF provides consistently high reliability with low complication rates across indications and techniques, while identifying venous congestion differences that may inform surgical decision-making and counseling.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.