Displaying the supraorbital/nasal plexus 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/nasal plexus. Objectives: The aim of this study was to evaluate, to what extent the supraorbital/nasal plexus can be determined by a dynamic 4D-CT Angiography (4D-CTA) and might have an influence on the preoperative forehead flap design for nasal reconstruction.

Methods From 2014 to 2020, 16 patients with complex 2- to 3-layered nasal defects underwent dynamic 4D-CTA preoperatively (Somaton Force, Siemens, Healthineers).

Results In 15 out of 16 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 73% 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

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Publication History

Article published online:
12 May 2023