Central Artery Perforator Propeller Flap for the Reconstruction of Nasal and Medial Canthal Tissue Defects

Introduction

Non-melanoma skin cancer is the most common type of skin cancer of the nose and medial canthal region, which is caused by chronic sun exposure[1]. The main goals for reconstruction of these areas are to provide color and texture match and to minimize donor-area morbidity[2].As the glabellar region has a rich vascular network, it is highly suitable for perforator flaps. Therefore, we designed a perforator propeller flap based on the central artery.

Patients and Methods

This prospective clinical study included 34 patients (14 females and 20 males) who had undergone surgery between January 2014 and March 2017. The median age of the patients was 60 (range: 19-88 years). All patients were followed up for at least 6 months.

Results

The pathological diagnoses were basal cell carcinoma(n=19) and squamous cell carcinoma (n=12). Two of the defects were after trauma. The median follow-up was nine months (ranged:6-32months). The size of the defects ranged from 2 x 2 to 4 x 5 cm, and that of the flaps ranged from 2 x 3.5 to 5x10 cm.We did not observe any major complications requiring surgery, such as total flap loss, hematoma, or dog-ear deformity. Venous congestion was observed in five patients, two of whom showed partial flap loss. Partial flap loss in largest flap (5 x 10cm)due to lack of arterial inflow into the tip of the flap. Although all of them healed without any intervention, only one required partial suture removal. None of the patients underwent secondary surgery for aesthetic reasons.

Discussion

The forehead flap is a safe and reliable option for the reconstruction of any skin component of the nose and medial canthal region. The disadvantages of the conventional forehead flap are as follows: need for at least one more surgery for pedicle separation, eyebrow deformity, vertical forehead scar, hair transfer to the reconstructed area, bulged-out appearance of the flap in comparison with the recipient area, and frequent occurrence of hypesthesia over the superior forehead (as the supratrochlear nerve is included in the flap) [3,4]. None of our patients experienced hypesthesia on the forehead and frontal scalp region, because the  flap was harvested medial to the supratrochlear and supraorbital nerves.

Conclusion

The central artery perforator propeller flap is a reliable option for the repair of large nasal defects and medial canthal region. This flap can cover large defects in single stage surgery without causing dog-ear deformity or eyebrow asymmetry.

References

1. Stal S, Spira M. Basal and squamous cell carcinoma of the skin. In: Grabb SJ, Beasley RW, Thorne CHM, editors. Plastic surgery. New York: Lippincott-Raven Publishers; 1997. 170-120.
2. Rohrich RJ, Griffin JR, Ansari M, et al. Nasal reconstruction beyond aesthetic subunits: a 15-year review of 1334 cases. Plast Reconstr Surg 2004;114(6):1417e9. 1405-16 discussion.
3. Konofaos P, Alvarez S, McKinnie JE, Wallace RD. Nasal recon- struction: a simplified approach based on 419 operated cases. Aesthet Plast Surg 2015 Feb;39(1):91-9.
4. Park SS. The single-stage forehead flap in nasal reconstruction: an alternative with advantages. Arch Facial Plast Surg 2002 Jan-Mar;4(1):32-6.