Early division of the paramedian forehead interpolated flap using cutaneous ultrasound

Abstract

Background and objectives:The paramedian forehead flap is an interpolated flap, consisting of the transfer of tissue from the forehead region to the nasal area, irrigated by the supratrochlear artery. Traditionally, the vascular pedicle is divided at between 14 and 21 days. However, this time could be overestimated. Our objective is to demonstrate that the paramedian forehead flap can be divided before that set out in the literature and to demonstrate the usefulness of cutaneous ultrasound to determine the optimal time for division. Patients and methods:A prospective observational study, including patients who required nasal defect reconstruction with a paramedian forehead flap, was designed. The inclusion criteria were: nasal tip, dorsum or alar skin defects following oncological surgery, larger than 2 cm. Twelve patients were included. A retrospective cohort was used to perform a cost reduction analysis. Results:The average time to flow, measured by ultrasound, was 6.6 days. The average number of days to division of the pedicle was 6.9 days. No serious complications were reported. Conclusions:The paramedian forehead flap can be divided before the traditional reported time. Ultrasound is a reliable and cost-effective technique to determine and individualize pedicle division time.

Skin ultrasonography and magnetic resonance; new clinical applications and instrumentation

“…8 HFUS is now used both to make sure that paramedian forehead interpolation flap contains a supratrochlear artery and there is an adequate blood flow in this flap prior to the pedicle division. 9 Skin ultrasonography is also utilized for an exact administration of hyaluronidase to remove an excessive and/or inappropriately placed hyaluronic acid cosmetic filler; HFUS also prevents inadvertent arterial hyaluronidase injection during this procedure. 10 Furthermore, HFUS is used to detect hyaluronic acid granulomas.…”

“…HFUS is now used as an imaging guide to visualize supratrochlear and supraorbital arteries during filler injections in a glabellar area and thus prevent inadvertent administration of the filler material into these vessels that can lead to potentially catastrophic results such as a blindness 8 . HFUS is now used both to make sure that paramedian forehead interpolation flap contains a supratrochlear artery and there is an adequate blood flow in this flap prior to the pedicle division 9 . Skin ultrasonography is also utilized for an exact administration of hyaluronidase to remove an excessive and/or inappropriately placed hyaluronic acid cosmetic filler; HFUS also prevents inadvertent arterial hyaluronidase injection during this procedure 10 .…”