Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications

Abstract

BackgroundPrevious studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators.MethodsSixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects.ResultsThe mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures.ConclusionsNasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.

Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study

“…The mechanisms that lead to tongue infarction from filler injection for chin augmentation require serious consideration. If the ascending mental artery coming from the submental artery is cannulated, retrograde injection into proximal part of the facial artery may cause infarction of the lips, nasolabial fold, nose, and paranasal skin depending on the distribution of branches of the facial artery . These complications can result when injections to define the jawline have been performed and injury to the facial artery occurred.…”

Nasolabial propeller perforator flap: Anatomical study and case series

“…Through the study described herein, we obtained the first anatomical description of cutaneous perforators of the terminal branches of the facial artery and its branching pattern in a South American population (from Colombia). To our knowledge, there are only five anatomical studies including perforators derived from the facial artery in the literature [3][4][5][6][7] (Table 3). While there are a handful of publications that refer to perforator flaps derived from the facial artery and their terminal branches (the superior labial, lateral nasal, and the angular arteries), [9][10][11][12][13][14][15][16] they include more inferior vascular territories to reconstruct cheek, superior lip and intraoral defects.…”

“…Table 4 summarizes the clinical experiences of the facial artery published to date. [3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20] When we assessed the nomenclature used and the design purposed in several of these clinical series, we determined that several of the cases did not involve true propeller perforator flaps; for example: if the angular artery is the vascular axis, that is an axial flap 11 or a peninsular flap (advancement or v-y flap), and even if you isolate several cutaneous perforators, the vascularization of the flap is also based on the subfascial or subsmach plexus. 12 A propeller flap pedicle, by definition, should be based on one perforator…”

“…Since the propeller concept for flap design was first described, it has broadened freedom in flap design to help reconstruction surgeons achieve both functional and cosmetic goals. Herein, we describe an anatomical study in a Colombian population to validate (by use of cadavers) the previous vascular anatomy descriptions of the facial artery perforator in the worldwide literature, and we report on seven clinical cases.…”

“…Herein, we describe an anatomical study in a Colombian population to validate (by use of cadavers) the previous vascular anatomy descriptions of the facial artery perforator in the worldwide literature, [3][4][5][6][7][8] and we report on seven clinical cases.…”