Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

Salvatore D'Arpa; Roberto Pirrello; Francesca Toia; Francesco Moschella; Adriana Cordova

doi:10.1055/s-0034-1376873

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2014; 30(03): 277-286
DOI: 10.1055/s-0034-1376873

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

Authors

Salvatore D'Arpa

¹Chirurgia Plastica e Ricostruttiva–Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
Roberto Pirrello

¹Chirurgia Plastica e Ricostruttiva–Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
Francesca Toia

¹Chirurgia Plastica e Ricostruttiva–Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
Francesco Moschella

¹Chirurgia Plastica e Ricostruttiva–Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
Adriana Cordova

¹Chirurgia Plastica e Ricostruttiva–Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy

Abstract

In 2009, we have described the use of freestyle facial artery perforator flaps for one-stage nose reconstruction. Since then, several articles have reported the use of facial artery perforator flaps for nose reconstruction. The purpose of this article is to provide an update of the published technique after 10 years of experience. Since 2004, 21 patients have been treated with a freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala. The flaps were 16 propellers, 4 V-Y, and 1 island transposition. A single venous congestion leading to a minor flap tip necrosis and a wound dehiscence was observed. All other flaps healed uneventfully. The V-Y design and multiple subunit reconstruction gave suboptimal results. It was concluded that indications for freestyle facial artery perforator flaps are total nasal alar subunit reconstruction or reconstruction of lateral alar defects when perforator anatomy allows. In these cases, freestyle facial artery perforator flaps are the first choice technique at our institution because they allow excellent results in one-stage operation. One-stage nasal ala reconstruction with freestyle facial artery perforator flaps.

Keywords

freestyle flap - propeller flap - perforator flap - facial artery perforator - nose - reconstruction

Full Text

References

References
1 Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg 2005; 115 (4) 996-1003 , discussion 1004–1005
2 Yoon TH, Yun IS, Rha DK, Lee WJ. Reconstruction of various perinasal defects using facial artery perforator-based nasolabial island flaps. Arch Plast Surg 2013; 40 (6) 754-760
3 D'Arpa S, Cordova A, Pirrello R, Moschella F. Free style facial artery perforator flap for one stage reconstruction of the nasal ala. J Plast Reconstr Aesthet Surg 2009; 62 (1) 36-42
4 Cordova A, D'Arpa S, Moschella F. A new one-stage method for nose reconstruction: the supratrochlear artery perforator propeller flap. Plast Reconstr Surg 2012; 129 (3) 571e-573e
5 Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plast Reconstr Aesthet Surg 2013; 66 (4) 483-488
6 Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg 2012; 129 (2) 421-429
7 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 (12) 1616-1620
8 Duzgun S, Unlu E, Bali Y. A new facial artery free-style perforator flap and conchal cartilage graft for one-step reconstruction of the alar defects. J Craniofac Surg 2013; 24 (6) 2053-2055
9 Krijgh DD, Mureau MA. Aesthetic and functional outcome following perioral defect reconstruction using the facial artery perforator flap. J Reconstr Microsurg 2012; 28 (8) 529-538
10 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (2) 113-141
11 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (5) 1529-1544
12 D'Arpa S, Cordova A, Pignatti M, Moschella F. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg 2011; 128 (4) 892-906
13 Ahmad QG, Shankhdhar VK. Novel flaps for head and neck reconstruction. Indian J Surg Oncol 2010; 1 (2) 120-124
14 Tan NC, Hsieh CH, Riva FM, Jeng SF. The nasolabial flap as a one-stage procedure for reconstruction of intermediate-to-large lip defects with functional and aesthetic assessments. J Plast Reconstr Aesthet Surg 2013; 66 (3) 352-357
15 Karsidag S, Ozcan A, Sumer O, Ugurlu K. Single-stage ala nasi reconstruction: lateral nasal artery perforator flap. J Craniofac Surg 2010; 21 (6) 1887-1889
16 Cordova A. Apporto innovativo dei lembi perforanti nella chirurgia del distretto testa-collo. Paper presented at: 62° Congresso Nazionale SICPRE; September 25–28, 2013; Bari, Italy
17 Pignatti M, Pasqualini M, Governa M, Bruti M, Rigotti G. Propeller flaps for leg reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 (7) 777-783
18 Teo TC. The propeller flap concept. Clin Plast Surg 2010; 37 (4) 615-626 , vi
19 Teo TC. Perforator local flaps in lower limb reconstruction. Cir Plast Iberolatinoam 2006; 32: 15-16
20 Hyakusoku H, Ogawa R, Oki K, Ishii N. The perforator pedicled propeller (PPP) flap method: report of two cases. J Nippon Med Sch 2007; 74 (5) 367-371
21 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (1) 53-54
22 Pignatti M, Ogawa R, Hallock GG , et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 2011; 127 (2) 716-722
23 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (2) 239-247
24 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (6, Suppl): e419-e426
25 Yildirim S, Taylan G, Aköz T. Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions. Ann Plast Surg 2007; 58 (5) 501-506
26 Ng ZY, Fogg QA, Shoaib T. Where to find facial artery perforators: a reference point. J Plast Reconstr Aesthet Surg 2010; 63 (12) 2046-2051
27 Wang R, Cen Y. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg 2012; 130 (5) 743e
28 Rossi M, Milia A, Carmisciano M, D'Arpa S, Cordova A, Moschella F. Advancement perforator cheek flap for aesthetic one-stage reconstruction of postoncological extended split-thickness defects of the nasal sidewall. ScientificWorldJournal 2013; 2013: 169208