Surgical pearls in forehead flap reconstruction after skin carcinoma. Case series

Background: The paramedian forehead flap based on the supratrochlear artery remains a fundamental technique in nasal and facial reconstruction following oncologic resection, particularly in the lower third of the nose, where skin color, thickness, and texture match are critical to aesthetic success. Objective: To describe the clinical outcomes and key technical considerations in nasal and facial reconstruction using the forehead flap, based on the experience of a tertiary care center in Mexico City. Methods: A retrospective, observational, and descriptive study was conducted, including patients over 18 years of age who underwent nasal or facial reconstruction with a forehead flap following oncologic excision between March 2022 and March 2025. Demographic data, oncologic diagnosis, defect location, surgical technique, and complications were recorded. Final aesthetic outcomes were subjectively evaluated by two independent plastic surgeons. Results: Five patients were included, with a mean age of 74.8 years. The majority were male (60%) and had comorbidities such as hypertension, diabetes, and COPD. Basal cell carcinoma of the nasal ala was the most common diagnosis. The forehead flap demonstrated high reliability, low complication rates, and satisfactory aesthetic outcomes. Technical refinements such as delayed thinning, aesthetic subunit planning, and Doppler-guided pedicle selection contributed to improved results. Conclusion: The forehead flap remains a reliable and versatile option for reconstructing complex nasal and perinasal defects in elderly oncologic patients. Meticulous preoperative planning, precise surgical technique, and staged refinements are essential to optimize outcomes. These strategies can be safely adopted in secondary and tertiary centers with reconstructive expertise. Keywords: forehead flap, surgical pearls, facial reconstruction, nasal reconstruction, surgical planning, supratrochlear artery, skin cancer, oncologic surgery, aesthetic subunits, reconstructive techniques.