Reconstruction of Various Perinasal Defects Using Facial Artery Perforator-Based Nasolabial Island Flaps

Abstract

BackgroundClassical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes.MethodsBetween December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation.ResultsEight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from 1 cm×1.5 cm to 3 cm×6 cm. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results.ConclusionsThe facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold.

The place of nasolabial flap in orofacial reconstruction: A review

“…The facial artery crosses the face below the expression muscle of the face and above the buccinator muscle [24], so the axial-pattern NLFs are thicker than random-pattern NLFs.The facial artery perforator-based NLF is a versatile flap that has the benefit of axial pattern blood supply through including a perforator branch from the facial artery and is thin because it is not necessary to include the facial artery and the expression muscle in the flap [25].…”

Nasolabial propeller perforator flap: Anatomical study and case series

“…Table 4 summarizes the clinical experiences of the facial artery published to date. [3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20] When we assessed the nomenclature used and the design purposed in several of these clinical series, we determined that several of the cases did not involve true propeller perforator flaps; for example: if the angular artery is the vascular axis, that is an axial flap 11 or a peninsular flap (advancement or v-y flap), and even if you isolate several cutaneous perforators, the vascularization of the flap is also based on the subfascial or subsmach plexus. 12 A propeller flap pedicle, by definition, should be based on one perforator…”

TEMA 6-2016: Técnicas de reconstrucción nasal tras resección de un carcinoma basocelular

“…(2,13,14) La nariz es el aspecto más prominente de la cara; el área perinasal representa la personalidad de una persona, es un área cosmética y funcionalmente importante. (15)(16)(17)(18)(19) Recordar que el paciente desea verse "normal", definido por la calidad de la piel y contorno tridimensional. (15,20) La presencia o ausencia de cicatrices es de menor importancia.…”

“…(21) Al elegir un procedimiento reconstructivo, se debe preferir seleccionar aquel que tenga la menor morbilidad a la vez que ofrezca la mayor probabilidad de éxito funcional y estético. (13,(15)(16)(17)19,22,23) El segundo concepto más importante en la reconstrucción involucra la comprensión adecuada de la anatomía y regiones topográficas de la cara. (15,17,21,22) La nariz se divide en subunidades respecto a sus diferentes estructuras de soporte, calidad de la piel y contorno.…”