Next To The Middle Of The Improved Forehead Flap Nasal Reconstruction Of The Anatomy And Clinical Application

ObjectiveBy investigating the course of the supratrochlear artery and make sure its relationship with the skin and the frontalis muscle to provide anatomic basis for the design of the modified paramedian forehead flap.MethodsSeven cadavers(twelve supratrochlear arteries)were used in the study. We recorded the initial position and the course of the supratrochlear artery(supraorbital rim and midline as landmarks)and the communication of the supratrochlear artery,the supraorbital artery and the frontal branch of the superficial temporal artery.The modified paramedian forehead flap which can be elevated without muscle,except for the pedicled part was designed and the course of the supratrochlear artery and the survival situation of the flap was observed.The colour and the contour of the reconstructed nose were followed up.ResultsThe supratrochlear artery exited the foramen supratrochlear which was(1.33±0.14)cm away from the midline and ascended inward.It had an oblique angle of about 82 degree towards the supraorbital rim level. The course of the supratrochlear artery can be divided into three parts, partⅠ,where the artery was located between the corrugator and orbicularis oculi muscles,from the initial position to the supraorbital rim level;partⅡ,close to the previous one,the artery piercing the frontalis muscle approximately at the supraorbital rim level and ascended on the surface of the frontalis muscle from the supraorbital rim level to the place (0.93±0.23)cm above it;and partⅢ,it ascended continuely within the subcutaneous plane and then intracutaneous plane.The branch of the supratrochlear artery was found at the level(1.26±0.20)cm above the supraorbital rim in five cadavers(eight supratrochlear arteries).And it ascended outward within the subcutaneous plane.Bilateral supratrochlear arteries communicated with each other.The supratrochlear artery communicated with the branch of the supraorbital artery and the frontal branch of the superficial temporal artery.The forehead arterial anastomotic plexus was organized by these arteries.No muscular branches was found in the frontalis muscle,the modified paramedian forehead flap was designed for the nasal reconstruction in three patients. During the operation,we found the supratrochlear traveled in the subcutaneous tissue of the forehead and no blood circulation barrier of the flaps happened.After the operation two flaps survived completely, and the partial necrosis of the flap which healed spontaneously happened in one patient.The postoperative aesthetic appearance was satisfactory.ConclusionsThe supratrochlear artery travels superficial to the frontalis muscle after it reaches the supraorbital rim level.The paramedian forehead flap which is elevated without muscle,except for the pedicled part can be designed.The reconstructed nose conforms to esthetics standard and it causes less damage to the forehead.