Supraorbital Artery Island Flap for Periorbital Defects

Abstract

The forehead skin has the same color and texture as the periorbital region as well as the other parts of the face. The forehead is a local flap donor area for the reconstruction of full-thickness periorbital defects. This report presents eight cases in which full-thickness defects resulting from tumor resection have been repaired with supraorbital artery island flaps. Of eight patients, one was female and the rest were male with a mean age of 72.8 years (range, 64-88 years). Defects were located in the medial canthal region, lateral canthal region, glabella, and lateral part of the orbita. The flaps ranged from 2 x 3 cm to 6 x 7 cm in size. The patients were followed for 7 to 18 months. No complications occurred, except for decreased sensation on the forehead, and trapdoor deformity was seen in one case. The outcome was functionally and aesthetically satisfactory in all cases and all patients were happy with the outcome. The supraorbital artery island flap is a good alternative for the repair of defects around the orbita in that the color and texture of this flap match up with the orbital region and that it is pliable, simple, safe, and sensorial and requires only a single-session procedure.

Frühe chirurgische Rehabilitation durch modifizierte orbitale Exenteration

“…Die lokalen Schwenklappen bieten eine gute Möglichkeit, die Heilung des epithesentragenden Orbitarands zu beschleunigen. Die periorbitale Region ist sehr gut durchblutet [10,11], dies dank der Anastomosen im subkutanen Gewebe [12]. Somit können auch mehrere Lappen kombiniert werden [8], und es ist uns möglich, selbst größere Defekte am anterioren Orbitarand problemlos zu decken.…”

“…Dies ist im Vergleich zu anderen Studien deutlich kürzer [7,17]. Die Bandbreite in der Literatur zur Versorgung der exenterierten Augenhöhle reichen von der spontanen Granulation [6,23], über alleinige Thiersch-Plastiken [6,7], lokale Lappenplastiken zur Deckung der gesamten Augenhöhle [4,7,24], gefäßgestielte Lappen [11,12,25,26], Temporalis-Muskellappen [16], Galea-Faszien-Lappen [3,20,27], faszio-zerviko-pektorale Lappen kombiniert mit Temporalis-Muskellappen [18] bis zu freien mikrovaskulären Lappen [17,19,20]. Auf der einen Seite braucht die spontane Granulation sehr viel Zeit und dauert 3-6 Monate [24,28].…”

One Stage Forehead Flap for Nasal Reconstruction

“…Okada and Maruyama reported a forehead flap based on the wide subcutaneous pedicle, including bilateral supraorbital and supratrochlear vessels, as compared with them in our study, the pedicle of the this flap was much longer and narrower less than 1 cm wide, including only unilateral supratrochlear vessels. [10] Kilinic and Bilen [11]reported one stage reconstruction island flap with a maximum size of 6×7 cm. they stated that the supratrochlear artery was found to consistently exit the superior medial orbit approximately 1.7 to 2.2 cm lateral to the midline, and continued its course vertically in a paramedian position approximately 2.0 cm lateral to the midline.…”

The Tunneled Forehead Flap in Medial Canthal and Eyelid Reconstruction

“…Pedicle reinsertion was required after some weeks. In 2007, Kilinç and Bilen 10 described the supraorbital artery island flap. The flap comprised the pericranium and required an additional eyebrow incision.…”

“…For the latter reason, the use of the flap is discouraged in the reconstruction of upper eyelid defects. For medial canthal and eyelid reconstruction, modifications of the median and paramedian forehead flap have been described that required free skin grafting, 5–8 secondary pedicle reinsertion, 9 additional eyebrow incising, 10 or extended subcutaneous tunneling 11 …”