{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:21:50Z","timestamp":1787548910975,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Total and subtotal full\u2010thickness nasal defects require simultaneous reconstruction of the internal lining, structural framework, and external soft\u2010tissue envelope. This study evaluated the clinical outcomes of a single\u2010stage approach combining an islanded paramedian forehead flap, hybrid lining, and titanium miniplate framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 14 patients who underwent reconstruction of total or subtotal full\u2010thickness nasal defects following oncologic resection between June 2020 and June 2025. The flap was transferred to the nasal defect through a subcutaneous tunnel. The internal lining was reconstructed using folded vascularized flap tissue combined with a split\u2010thickness skin graft. Structural support was provided by longitudinal and transverse titanium miniplates secured at four bony fixation points. Patient\u2010reported functional and aesthetic outcomes were assessed using the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean patient age was 69\u2009years (range, 55\u201394\u2009years); 10 patients (71.4%) had at least one comorbidity, and 12 were classified as American Society of Anesthesiologists physical status III or IV. Eleven patients had total defects and three had subtotal defects. The mean flap dimensions were 7.6\u2009\u00d7\u20095.8\u2009cm. The mean reconstruction time was 57\u2009min (range, 43\u201378\u2009min), and the mean follow\u2010up duration was 18\u2009months (range, 14\u201324\u2009months). Two complications occurred (14.3%): limited plate exposure and partial flap necrosis. Both were managed with debridement and primary closure without plate removal. No total flap loss, infection, wound dehiscence, nasocutaneous fistula, or clinical structural instability occurred. Postoperative computed tomography in 11 patients demonstrated no plate displacement, screw loosening, or fixation failure. No patient required pedicle division. Twelve patients completed the NAFEQ; the mean functional and aesthetic subscale scores were 22.5\u2009\u00b1\u20093.0 and 26.1\u2009\u00b1\u20096.1, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combined use of an islanded paramedian forehead flap, hybrid nasal lining, and a titanium framework secured at four fixation points may provide a single\u2010stage reconstructive option for selected patients with total or subtotal full\u2010thickness nasal defects. This approach may be particularly considered for patients in whom prolonged microsurgical reconstruction could impose an additional surgical and physiological burden because of advanced age or comorbidities, as well as for those who decline multistage reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70932","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:13:17Z","timestamp":1787548397000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single\u2010Stage Three\u2010Layer Total and Subtotal Nasal Reconstruction: An Islanded Paramedian Forehead Flap, Hybrid Lining, and Titanium Support Framework"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8878-8660","authenticated-orcid":false,"given":"Ahmet","family":"Koyuncu","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Necmettin Erbakan University  Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7607-561X","authenticated-orcid":false,"given":"Yi\u011fitcan","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Necmettin Erbakan University  Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-3414","authenticated-orcid":false,"given":"G\u00fcl\u00e7in","family":"B\u00fcy\u00fckbezirci","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation Necmettin Erbakan University  Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-1389","authenticated-orcid":false,"given":"Mehmet","family":"Dadac\u0131","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Necmettin Erbakan University  Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"15e","DOI":"10.1097\/01.prs.0000298113.56554.c3","article-title":"Complex Nasal Reconstruction","volume":"121","author":"Taghinia A. H.","year":"2008","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.cps.2009.02.015","article-title":"Nasal Reconstruction With a Forehead Flap","volume":"36","author":"Menick F. J.","year":"2009","journal-title":"Clinics in Plastic Surgery"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/014556131509400302","article-title":"The Paramedian Forehead Flap for Nasal Lining Reconstruction","volume":"94","author":"Rosenberg J. D.","year":"2015","journal-title":"Ear, Nose, & Throat Journal"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/SCS.0000000000004976","article-title":"The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present","volume":"30","author":"Shokri T.","year":"2019","journal-title":"Journal of Craniofacial Surgery"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/00006534-198508000-00010","article-title":"The Subunit Principle in Nasal Reconstruction","volume":"76","author":"Burget G. 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J.","year":"2003","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/SAP.0000000000000209","article-title":"A Cohort Study of Paramedian Forehead Flap in 2 Stages (87 Flaps) and 3 Stages (100 Flaps)","volume":"75","author":"Santos Stahl A.","year":"2015","journal-title":"Annals of Plastic Surgery"},{"key":"e_1_2_12_10_1","first-page":"697","article-title":"Total Nasal Reconstruction: Use of a Radial Forearm Free Flap, Titanium Mesh, and a Paramedian Forehead Flap","volume":"39","author":"Henry E. L.","year":"2010","journal-title":"Journal of Otolaryngology \u2010 Head & Neck Surgery"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1097\/00005537-199708000-00015","article-title":"Nasal Reconstruction Using a Combination of Alloplastic Materials and Autogenous Tissues: A Surgical Alternative","volume":"107","author":"Bikhazi N. B.","year":"1997","journal-title":"Laryngoscope"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s10439-025-03916-7","article-title":"Tissue\u2010Engineered Cartilage for Nasal Reconstruction: Mechanical Stimulation Through Bidirectional Bending","volume":"54","author":"Rafieian S.","year":"2026","journal-title":"Annals of Biomedical Engineering"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3390\/dj13020052","article-title":"The Early Exposure Rate and Vertical Bone Gain of Titanium Mesh for Maxillary Bone Regeneration: A Systematic Review and Meta\u2010Analysis","volume":"13","author":"Lorusso F.","year":"2025","journal-title":"Dental Journal"},{"key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1524-4725.2008.34425.x","article-title":"Nasal Reconstruction With Titanium Mesh","volume":"35","author":"Rodriguez\u2010Prieto M. A.","year":"2009","journal-title":"Dermatologic Surgery"},{"key":"e_1_2_12_15_1","first-page":"4","article-title":"Total Nasal Reconstruction With a Titanium Miniplate as Structural Support","volume":"114","author":"Lari N.","year":"2013","journal-title":"Revue de Stomatologie, de Chirurgie Maxillo\u2010Faciale et de Chirurgie Orale"},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1002\/micr.30302","article-title":"Total Nasal Reconstruction With 3D Custom\u2010Made Porous Titanium Prosthesis and Free Thoracodorsal Artery Perforator Flap: A Case Report","volume":"38","author":"Qassemyar Q.","year":"2018","journal-title":"Microsurgery"},{"key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"1420673","DOI":"10.3389\/fsurg.2024.1420673","article-title":"Case Report: A New Variant of the Forehead Flap for Subtotal Nose Reconstruction in a Single Stage: The Dragonfly Flap","volume":"11","author":"Brambullo T.","year":"2024","journal-title":"Frontiers in Surgery"},{"key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/22925503211011973","article-title":"Is Irradiated Homologous Costal Cartilage Reliable? A Meta\u2010Analysis of Complication Rates in Rhinoplasty","volume":"30","author":"Kadakia N.","year":"2022","journal-title":"Plastic Surgery"},{"key":"e_1_2_12_19_1","first-page":"1022","article-title":"Incorporation of Titanium Mesh in Orbital and Midface Reconstruction","volume":"110","author":"Schubert W.","year":"2002","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.3349\/ymj.2014.55.6.1617","article-title":"Problems Associated With Alloplastic Materials in Rhinoplasty","volume":"55","author":"Kim H. S.","year":"2014","journal-title":"Yonsei Medical Journal"},{"key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/j.1365-2133.2009.09257.x","article-title":"Partial Nasal Reconstruction With Titanium Mesh: Report of Five Cases","volume":"161","author":"Rodriguez\u2010Prieto M. 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M.","year":"2015","journal-title":"International Journal of Dermatology"},{"key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"e410","DOI":"10.1097\/SCS.0b013e31825cef78","article-title":"Reconstruction of a Near\u2010Total Nasal Defect Using a Precontoured Titanium Mesh With a Converse Scalping Flap","volume":"23","author":"Horn D.","year":"2012","journal-title":"Journal of Craniofacial Surgery"},{"key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"1330889","DOI":"10.3389\/fsurg.2024.1330889","article-title":"Case Report: Pediatric Alloplastic Nose Reconstruction With a 3D Printed Patient\u2010Specific Titanium Implant","volume":"11","author":"Ureel M.","year":"2024","journal-title":"Frontiers in Surgery"},{"key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"e99","DOI":"10.1097\/SCS.0000000000002244","article-title":"Use of a Titanium Microplate to Anchor Subunit Reconstruction at the Nasal\u2010Cheek Junction","volume":"27","author":"Czerwinski M.","year":"2016","journal-title":"Journal of Craniofacial Surgery"},{"key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"405e","DOI":"10.1097\/01.prs.0000475792.38984.37","article-title":"Treatment Outcome of the Transfacial Titanium Epiplating System for Total Nasal Defects","volume":"137","author":"Lunenburger H.","year":"2016","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_12_27_1","doi-asserted-by":"crossref","first-page":"e6506","DOI":"10.1097\/GOX.0000000000006506","article-title":"Nasal Reconstruction With Forehead Flap: Our 12\u2009Years' Experience","volume":"13","author":"D'Antonio S.","year":"2025","journal-title":"Plastic and Reconstructive Surgery, Global Open"},{"key":"e_1_2_12_28_1","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/jdv.12114","article-title":"Reconstruction of Nasal Defects With Forehead Flaps in Patients Older Than 75\u2009Years of Age","volume":"28","author":"Kendler M.","year":"2014","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"key":"e_1_2_12_29_1","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.bjps.2007.07.024","article-title":"Validation of a Questionnaire Assessing Patient's Aesthetic and Functional Outcome After Nasal Reconstruction: The Patient NAFEQ\u2010Score","volume":"62","author":"Moolenburgh S. E.","year":"2009","journal-title":"Journal of Plastic, Reconstructive & Aesthetic Surgery"},{"key":"e_1_2_12_30_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/SAP.0b013e3181c925fc","article-title":"Single\u2010Stage Forehead Flap in Nasal Reconstruction","volume":"64","author":"Fudem G. M.","year":"2010","journal-title":"Annals of Plastic Surgery"},{"key":"e_1_2_12_31_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/00006534-199908000-00005","article-title":"Prelaminated Free Flap Reconstruction of Complex Central Facial Defects","volume":"104","author":"Pribaz J. J.","year":"1999","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_12_32_1","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.joms.2010.07.031","article-title":"Nasal Reconstruction: Experience Using Tissue Expansion and Forehead Flap","volume":"69","author":"Kheradmand A. A.","year":"2011","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"issue":"1","key":"e_1_2_12_33_1","first-page":"E619","article-title":"Recommendations for Implant\u2010Retained Nasal Prostheses After Ablative Tumor Surgery: Minimal Surgical Aftercare, High Implant Survival, and Satisfied Patients","volume":"38","author":"Korfage A.","year":"2016","journal-title":"Head & Neck"},{"key":"e_1_2_12_34_1","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.prosdent.2018.03.032","article-title":"Maxillofacial Prosthetic Rehabilitation: A Survey on the Quality of Life","volume":"120","author":"Dings J. P. P.","year":"2018","journal-title":"Journal of Prosthetic Dentistry"},{"key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.3390\/healthcare11121785","article-title":"Reconstructive Options After Oncological Rhinectomy: State of the Art","volume":"11","author":"Migliorelli A.","year":"2023","journal-title":"Healthcare"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70932","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70932","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70932","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:13:22Z","timestamp":1787548402000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70932"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":34,"alternative-id":["10.1111\/ans.70932"],"URL":"https:\/\/doi.org\/10.1111\/ans.70932","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]},"assertion":[{"value":"2026-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ans.70932"}}