Two-Stage Reconstruction of the Frontonasal Flap with Pedicle Release: Case Report and Surgical Technique

Two-stage reconstruction of the frontonasal flap with delayed pedicle release is a reliable technique for the management of nasal ala defects, particularly in older patients with basal cell carcinoma. We present the case of a 70-year-old male with a 2.5 cm ulcerated basal cell carcinoma affecting the right nasal ala, involving the lateral curvature, alar line, and adjacent nasal base skin. Complete oncologic excision was performed with preservation of nasal cartilaginous support, followed by coverage with a laterally based frontonasal flap. In the first stage, the flap was transferred to the defect while maintaining the vascular pedicle intact to ensure perfusion. After 21 days, the pedicle was carefully released in a second-stage procedure, allowing precise adjustment of contour, symmetry, and alar curvature without compromising vascular supply. Postoperative outcomes demonstrated complete flap survival, optimal aesthetic integration, and functional preservation, with high patient satisfaction. This case highlights the effectiveness of a two-stage frontonasal flap with delayed pedicle release for nasal ala reconstruction in high-risk populations. The approach ensures vascular safety, allows secondary refinement, and provides superior aesthetic and functional results compared with single-stage or alternative local flap techniques. The report underscores the clinical relevance of meticulous planning, staged transfer, and pedicle management in complex nasal reconstruction.