Midface reconstruction with various flaps based on the angular artery.
OBJECTIVE
Although several methods can be used to perform midface reconstruction, difficulties exist in selecting the appropriate method because of anatomic and functional complexities, donor site morbidities, and poor esthetic results. The purpose of this study was to develop an alternative reconstructive method for the midface using various flaps based on the angular artery.


METHODS
We investigated the relation between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by use of island composite nasal flaps.


RESULTS
The angular artery was reliable as a pedicle whether it was used in an antegrade or retrograde manner. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The esthetic outcomes for the donor and recipient sites were acceptable.


CONCLUSIONS
The angular artery has diverse relations with its surrounding structures according to its course of travel, and if the surgeon has a precise understanding of its anatomic location, we believe that retroangular flaps and island composite nasal flaps may prove useful for the treatment of midface defects.
Seo
Young-Joon
YJ
Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, South Korea.
Hwang
Chul
C
Choi
Sangmun
S
Oh
Sang-Ha
SH
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation; D002102:Cadaver; D002280:Basal Cell Carcinoma / Q000601:surgery; D004210:Dissection; D004954:Esthetics; D005142:Eyelid Neoplasms / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005145:Face / Q000601:surgery*; D005152:Facial Muscles / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery; D009669:Nose Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods / Q000473:pathology*; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome