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The value of dynamic 4D-CT Angiography for preoperative flap design in complex nasal reconstruction
Background The paramedian forehead flap is an axial pattern flap with frequent use in plastic reconstruction of complex nasal defects. Its main blood supply is based on the supratrochlear artery as part of the supraorbital and nasal plexus. It consists of the supratrochlear artery, the infratrochlear, the supraorbital, the ophthalmic, the dorsal nasal as well as the angular artery.
Objectives The aim of this ongoing pilot study was to determine the value of dynamic 4D-CT Angiography (4D-CTA) for assessment of the supraorbital/nasal plexus and to evaluate, to what extend it might influence the preoperative forehead flap design for nasal reconstruction.
Methods From 2014 to 2019, 13 patients with complex 2- to 3-layered nasal defects underwent dynamic 4D-CTA preoperatively (Somatom Force, Siemens Healthcare, Forchheim, Germany).
Results In 12 out of 13 patients the perfusion of the supraorbital plexus could be visualized and integrated into the preoperative reconstruction plan, which failed in one patient.
The supraorbital plexus on both sides of the face demonstrated a different pattern of vascular perfusion. In 61 % of the cases, this information had an influence on the preoperative flap design as the artery with the highest contrast defined the side of the forehead to be chosen.
Conclusions This study underlines the value of dynamic 4D-CTA in nasal reconstruction as it enables a better anatomical understanding of the vascular structures in the forehead region.
Article published online:
10 June 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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