Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

Abstract

Facial artery perforator flaps were first introduced by Hofer et al 1 in 2005 for reconstruction of perioral defects. 2 Hofer et al introduced the fascinating concept of perforator flaps in the face. We have then described the freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala, 3 expanding the potential of these flaps and introducing the concept of one-stage nose reconstruction that we have later applied to the forehead flap too. 4 These flaps have prompted a great interest for the anatomy of the facial artery perforators 5,6 and for the applications of facial artery perforator flaps, which seem to have gained their place in face reconstruction. 2,5,[7][8][9] In this article, we report our long-term experience to provide an update after the first published article. Many times some techniques are lost to follow-up, while it is very useful to know if the authors have improved themand how-or abandoned them-and why. Facial Artery AnatomyAlthough the exact position of a single perforator varies and requires accurate preoperative and intraoperative identification, perforator anatomy is still predictable and constant: the source arteries give their perforators to the skin in fixed areas of the body. A fixed area is a region where anatomical planes are firmly attached and do not glide, or glide less. This allows for vessel protection from shearing and for shorter and more direct course to the skin. 10 The facial artery sticks to this rule. It constantly gives off several perforators to the skin at the level of the nasolabial sulcus, a fixed area in the face.An average of 5.05 AE 0.86 facial artery perforators of more than 0.5 mm can be found above the mandible. The average diameter of these perforators at their origin from the facial artery is 0.96 AE 0.21 mm. Based on injection studies the territory that these perforators can supply has an average AbstractIn 2009, we have described the use of freestyle facial artery perforator flaps for onestage nose reconstruction. Since then, several articles have reported the use of facial artery perforator flaps for nose reconstruction. The purpose of this article is to provide an update of the published technique after 10 years of experience. Since 2004, 21 patients have been treated with a freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala. The flaps were 16 propellers, 4 V-Y, and 1 island transposition. A single venous congestion leading to a minor flap tip necrosis and a wound dehiscence was observed. All other flaps healed uneventfully. The V-Y design and multiple subunit reconstruction gave suboptimal results. It was concluded that indications for freestyle facial artery perforator flaps are total nasal alar subunit reconstruction or reconstruction of lateral alar defects when perforator anatomy allows. In these cases, freestyle facial artery perforator flaps are the first choice technique at our institution because they allow excellent results in one-stage operation. One-stage nasal ala reconstruction with...

Propeller Flaps: A Review of Indications, Technique, and Results

“…Free-style flaps can be based on perforators of the facial artery and have been successfully used as propeller flaps for nasal ala reconstruction in a single stage [5–9, 11, 13, 20, 21]. …”

Redefining Fasciocutaneous Microanatomy: An Illustrated Review of Current Concepts and Their Clinical Correlates

“…Perforator diameter relates to tissue mobility and laxity [22]. In the face, arterial perforators are larger and closer to veins caudally compared to cranially [58].…”

Pacman flap for oncologic reconstruction of soft-tissue defects after tumor resection

“…The perforator flap has become a common option for defect reconstruction after tumor resection. [ 12 – 16 ] The perforator flap achieves satisfactory aesthetic and functional results; however, the complex microsurgical skills required, prolonged operative time, and steep technical learning curve have limited its widespread use. Therefore, local rotational flaps and bilateral or unilateral V-Y advancement flaps are often used to close round soft-tissue defects.…”