Evaluation of surgical outcomes of wide local excision and nasal reconstruction using forehead island flaps for skin cancer management
Nasal reconstruction; Island forehead flap; Basal cell carcinoma; Single-stage; Head and neck oncoplastic surgery.
AuthorsAbstractBackground: Nasal defects resulting from oncological resection present significant reconstructive challenges due to complex facial anatomy and physiological demands. This study evaluated the clinical efficacy, aesthetic and functional outcomes, and complication profiles of the single-stage island forehead flap for nasal reconstruction following skin cancer excision. Methods: A descriptive, non-controlled clinical trial was conducted at Ho Chi Minh City Oncology Hospital (January 2023–December 2025). Thirty-four patients with AJCC 8th edition stage T1–T4a nasal skin cancer underwent wide local excision followed by immediate single-stage island forehead flap reconstruction based on a unilateral supratrochlear vascular pedicle. Results: The cohort predominantly presented with basal cell carcinoma (94.1%). The mean defect area was 6.68 ± 4.34 cm², with 58.8% exceeding 4 cm². The mean operative time was 52.25 ± 12.57 minutes, which significantly correlated with defect size (p = 0.039) and estimated blood loss (p = 0.006). All patients achieved negative surgical margins (R0) with zero local recurrence or regional nodal metastasis during a mean follow-up of 24.74 ± 2.67 months. The flap survival rate was 100%. Early minor complications occurred in 8.82% of cases (venous congestion and wound dehiscence), all managed conservatively. At 6 months postoperatively, 94.1% of patients achieved excellent or good aesthetic outcomes, and 100% reported long-term subjective functional satisfaction. Conclusion: The single-stage island forehead flap is an oncologically safe, reliable, and highly efficient modality for extensive nasal reconstruction. It offers superior structural contour restoration and high patient satisfaction while eliminating the need for a secondary staged procedure.
IntroductionSkin cancer predominantly occurs in the head and neck region, accounting for 90% of all skin cancer cases.[1] Head and neck skin cancers comprise two main histological types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), with BCC constituting the majority (approximately 80% of all cases).[2] Nasal skin cancer accounts for about 25% of head and neck skin cancers.[4] The primary treatment modality is wide local excision to achieve complete tumor clearance while ensuring oncologically safe surgical margins. The nose is a complex three-dimensional structure located in the midface, playing a vital role in both facial architecture and aesthetics. Consequently, nasal defects attract greater attention compared to other facial regions, posing significant reconstructive challenges. Functionally, the nose serves as the gateway to the respiratory system, responsible for warming, humidifying, and filtering inspired air. •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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