Application Of Nasolabial Fold Flap Pedicled With Inner Canthus-angular Artery In The Repair Of Midface Defects

Objective: To investigate the clinical efficacy of the inner canthus-angular artery nasolabial flap in the reconstruction of the midface defects such as lower eyelid,nasal and upper lip defects by subcutaneous pedicle or local rotation.Methods: Inner canthus-angular artery nasolabial flap was performed in the 10 cases of lower eyelid defects,7 cases of nasal and 3 cases of upper lip defects after the removal of facial tumors from the Second Affiliated Hospital of Fujian Medical University from August 2014 to July 2018,including 12 females and 8 males,aged 52~86 years,mean age 67,the minimum defect area is 1.2cm×1.2cm,the maximum defect area is 3.5cm×1.7cm,Preoperative Doppler ultrasound blood flowmeter was used to locate and marks the angular artery in the inner canthus.The extent and depth of the resection are depended on the pathological type of the tumor.The defects were completely hemostasis,and the size of defects were measured.According to the size of defect,the pedicle of superiorly based nasolabial was designed with the course of inner canthus-angular artery.The flap was separated from the design line to the SMAS fascia layer on the surface of the expression muscle.Lift the flap,separate the pedicle appropriately,the fat and connective tissue should be included in the pedicle.The pedicle is transferred to repair the defect under the condition of no tension by rotation or subcutaneous tunnel.The wounds were intermittently sutured with 6-0 Prolene whitout any tension.In general,the donor sites can be sutured directly after subcutaneous segregation.After the hemostasis,suture the subcutaneous tissue with 5-0 Vicryl to reduce the skin tension.The epidermis is sutured with 6-0 Prolene,A drain should be left for drainage in the donor area and the affected area,the bandaged areas were appropriately pressurized,the drain was removed after 2-3 days.Results: A total of 20 patients in this study were followed up for 1 months to 48 months.All flaps survived with one-stage reconstruction.One of the cases had blockage of venous return after operation which resulted in cyanosis and edema in the recipient area.Flap blood supply recovered 2 weeks after surgery with the applyment of vasodilator?oxygen and flap massage,the flap survived,there was no ectropion,secondary deformity of lip and nose and internal canthus displacement and other complications,none of flaps was striking bulkiness,the color and texture of the flaps are similar to those of adjacent tissues which is unnecessary for secondary repair.The donor sites are just right the nasolabial fold,there is no tumor recurrence.Conclusions: The inner canthus-angular artery nasolabial flap reliable in blood supply is easy to obtain whose scars can be hidden.This flap is easy to transfer to repair the deflects of the nose,upper lip and lower eyelid.Most of the surgery can be performed under local anesthesia.This flap not only provide good wound healing for the midfacial reconstruction but also has good aesthetic and functional effects especially in elderly.This kind of flaps has a high clinical promotion and application value.