Prefabricated 3D Template-Guided Paramedian Forehead Flap Reconstruction for Nasal Cutaneous Malignancy Defects: A Comparative Cohort Study

BACKGROUND: The paramedian forehead flap (PMFF) is the workhorse of nasal reconstruction following cutaneous malignancy excision. Traditional intraoperative templating is limited by soft tissue edema, wound collapse, and defect distortion. Prefabricated 3D templates represent a promising alternative; however, comparative patient-reported outcome data remain sparse. METHODS: A retrospective comparative cohort study was conducted of 93 adults with non-melanoma nasal cutaneous malignancies who underwent two-staged PMFF reconstruction between 2015 and 2020. Twenty-three patients treated before institutional 3D scanning adoption received traditional Steri-Strip templates (Group 1); 70 treated after workflow integration received prefabricated 3D laser-scanned templates (Group 2). Outcomes were assessed using the NOSE, ROE, FROI-17, and Skin Cancer Index. RESULTS: Demographics were comparable between groups. Group 2 demonstrated superior functional outcomes on the NOSE (8.0±5.9 versus 12.7±3.5; P=0.001) and FROI-17 (11.2±1.4 versus 22.9±8.4; P<0.001), and superior aesthetic outcomes on the ROE (21.2±3.7 versus 14.7±4.7; P<0.001). SCI scores were equivalent (P=0.936). Complication and revision rates were comparable. The observed between-group difference on the primary outcome corresponded to a Cohen's d of 0.87, indicating a large effect size. CONCLUSIONS: Within this retrospective single-surgeon series, prefabricated 3D template-guided PMFF reconstruction was associated with significantly improved patient-reported functional and aesthetic outcomes without increasing complication or revision rates, supporting broader integration of 3D scanning into nasal reconstructive planning.