Minimally Invasive Microdebrider Sculpting of Paramedian Forehead Flaps

Abstract

Introduction:

Paramedian forehead flaps (PMFF) are an excellent reconstructive option for nasal defects, however, the skin is intrinsically thicker than the surrounding nasal tissue. Traditionally, flap thinning requires incising as much as 50% of the flap edge and trimming using a scalpel or scissors. This can pose a risk to the flap if too much of the perimeter blood supply is disrupted, and it is challenging to reach distal aspects of the flap. The microdebrider is often used for removing tissue in sinus surgery, but we have adapted it for use in the debulking of PMFF.

Methods:

Patients who underwent PMFF reconstruction of a nasal defect from September 2020 to December 2022 were identified. This timeframe equally divides a period before use of the microdebrider for debulking and after. Primary outcome was flap volume reduction. Secondary outcomes included flap injury/failure rate and need for additional procedures to address cosmetic concerns.

Results:

Twenty-four patients were identified and 12 met inclusion criteria. The microdebrider was utilized for PMFF debulking on 7 of these patients. Cold steel instrument debulking was utilized on 5 patients. Total volume reduction was not statistically significant between flap debulking using the microdebrider versus cold steel instruments (p = 0.53).

Conclusion:

PMFF debulking with a microdebrider is comparable to debulking with traditional cold steel instruments. A larger sample size and prospectively conducted study could be beneficial to compare the 2 techniques regarding efficiency in operating room procedure times, real-time measurement of flap thickness and volume before and after debulking, flap injury rates, and cosmetic outcomes.

Disclosure Statement:

None of the authors in this study have any conflicts of interest or disclosures to report.

Source of Study:

Research material was obtained from chart review and previously obtained pre-procedure and postoperative photographs.

Ethics Approval and Patient Consent:

This study was adherent to protocols of the University of Oklahoma Health Sciences Center Institutional Review Board (IRB #15265). Informed consent for sharing and publishing of results and images was obtained from all patients.

Running Time: 3 mins, 21 secs.