Purpose:
Traditional three-stage paramedian forehead flap is the gold standard in nasal reconstruction. Based on the subunits concept, the forehead flap provides a sufficient amount of soft tissue from a single unit to total nose reconstruction.
Besides, nasal reconstruction usually requires autologous cartilage grafting and alloplastic implants. Infection, protrusion, or capsular contracture of the implant is not uncommon. Traditionally, multiple struts cartilage grafts from the rib, conchal, or septum can provide adequate support to achieve a good aesthetic outcome. In this article, the author applies a one-piece L shape rib graft for nasal reconstruction with a forehead flap.

Materials and Methods:
From March 2020 to June 2021, nine patients received nasal reconstruction with a paramedian forehead flap. The etiology of alar defects were malignancy, trauma, and benign neoplasm. In our method, a paramedian forehead flap with preoperative 3D printing-assisted was designed to reconstruct the nasal defect. A single-piece L-shape autologous rib graft provides adequate frame support. After 3-staging division and revision, cephalophotography was evaluated at our outpatient department.

Results:
A total of 9 patients received nasal reconstruction with forehead flap and L shape autologous rib graft, 5 males and 4 males. The mean age was 40.56±17.84 years old. The mean follow-up time was 11.73±5.11 months. Only 3 cases reported complications including flap partial loss or infection. The final outcome of the L shape was optimal and acceptable.

Conclusion:
Rhinoplasty with forehead flap is the gold standard for congenital and acquired nasal defects. Compared to the traditional multiple-strust autologous cartilage grafts, a single-piece rib graft provide a rigid, and reliable framework support.

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