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Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications

  • Received : 2015.08.27
  • Accepted : 2015.11.24
  • Published : 2016.01.15

Abstract

Background Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. Methods Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. Results The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. Conclusions Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.

Keywords

References

  1. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994;32:32-8. https://doi.org/10.1097/00000637-199401000-00007
  2. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42:645-8. https://doi.org/10.1016/0007-1226(89)90075-1
  3. Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg 2005;115:996-1003. https://doi.org/10.1097/01.PRS.0000154208.67390.5C
  4. D’Arpa S, Cordova A, Pirrello R, et al. Free style facial artery perforator flap for one stage reconstruction of the nasal ala. J Plast Reconstr Aesthet Surg 2009;62:36-42. https://doi.org/10.1016/j.bjps.2008.06.057
  5. Karsidag S, Ozcan A, Sumer O, et al. Single-stage ala nasi reconstruction: lateral nasal artery perforator flap. J Craniofac Surg 2010;21:1887-9. https://doi.org/10.1097/SCS.0b013e3181f4af27
  6. Brunetti B, Tenna S, Aveta A, et al. Angular artery perforator flap for reconstruction of nasal sidewall and medial canthal defects. Plast Reconstr Surg 2012;130:627e-628e. https://doi.org/10.1097/PRS.0b013e318262f6ac
  7. Sohn WI, Choi JY, Seo BF, et al. Reconstruction of nasal ala with nasolabial perforator flap after cancer removal. Head Neck Oncol 2012;4:83.
  8. Kim SW, Kim YH, Kim JT. Angular artery perforator-based transposition flap for the reconstruction of midface defect. Int J Dermatol 2012;51:1366-70. https://doi.org/10.1111/j.1365-4632.2012.05516.x
  9. Demirseren ME, Afandiyev K, Ceran C. Reconstruction of the perioral and perinasal defects with facial artery perforator flaps. J Plast Reconstr Aesthet Surg 2009;62:1616-20. https://doi.org/10.1016/j.bjps.2008.07.037
  10. Kim JT. New nomenclature concept of perforator flap. Br J Plast Surg 2005;58:431-40. https://doi.org/10.1016/j.bjps.2004.12.009
  11. Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plast Reconstr Aesthet Surg 2013;66:483-8. https://doi.org/10.1016/j.bjps.2012.11.027
  12. Ng ZY, Fogg QA, Shoaib T. Where to find facial artery perforators: a reference point. J Plast Reconstr Aesthet Surg 2010; 63:2046-51. https://doi.org/10.1016/j.bjps.2010.01.002
  13. Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg 2012;129:421-9. https://doi.org/10.1097/PRS.0b013e31822b6771
  14. Nakajima H, Imanishi N, Aiso S. Facial artery in the upper lip and nose: anatomy and a clinical application. Plast Reconstr Surg 2002;109:855-61. https://doi.org/10.1097/00006534-200203000-00003
  15. Loukas M, Hullett J, Louis RG Jr, et al. A detailed observation of variations of the facial artery, with emphasis on the superior labial artery. Surg Radiol Anat 2006;28:316-24. https://doi.org/10.1007/s00276-006-0093-0
  16. Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985;76:239-47. https://doi.org/10.1097/00006534-198508000-00010
  17. Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg 2003;30:473-80. https://doi.org/10.1016/S0094-1298(03)00047-6
  18. Menick FJ. Nasal reconstruction with a forehead flap. Clin Plast Surg 2009;36:443-59. https://doi.org/10.1016/j.cps.2009.02.015
  19. Cameron RR, Latham WD, Dowling JA. Reconstructions of the nose and upper lip with nasolabial flaps. Plast Reconstr Surg 1973;52:145-50. https://doi.org/10.1097/00006534-197308000-00007
  20. Fabrizio T, Savani A, Sanna M, et al. The retroangular flap for nasal reconstruction. Plast Reconstr Surg 1996;97:431-5. https://doi.org/10.1097/00006534-199602000-00025
  21. Chu EA, Byrne PJ. Local flaps I: bilobed, rhombic, and cervicofacial. Facial Plast Surg Clin North Am 2009;17:349-60. https://doi.org/10.1016/j.fsc.2009.05.003
  22. Kwon KH, Lee DG, Koo SH, et al. Usefulness of v-y advancement flap for defects after skin tumor excision. Arch Plast Surg 2012;39:619-25. https://doi.org/10.5999/aps.2012.39.6.619
  23. Tregaskiss A, Allan J, Gore S, et al. Use of the nasal sidewall island inversion flap for single-stage ala nasi reconstruction: a report of 103 consecutive cases. Plast Reconstr Surg 2014; 133:377-85. https://doi.org/10.1097/01.prs.0000436797.81928.24
  24. Brunetti B, Tenna S, Aveta A, et al. Free-style local perforator flaps: versatility of the v-y design to reconstruct soft-tissue defects in the skin cancer population. Plast Reconstr Surg 2013;132:451-60. https://doi.org/10.1097/PRS.0b013e3182958897

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