The Study Of The Arterial Anatomy Of The Subcutaneous Island Pedicle Nasolabial Flap And Its Application In The Reconstruction Of Nasal Partial Defects

Objective To study the arterial anatomy of nasolabial groove region and its relevance to the design of the subcutaneous island pedicle nasolabial flap, to provide anatomic basis for the design of subcutaneous island pedicle nasolabial flap and its clinical application in the reconstruction of nasal partial defects. Methods The microanatomy of blood vessels of nasolabial groove region was investigated using 10 adult cadavers and 20 nasolabial groove regions were anatomized in subdermal, first fascial and deep level under a surgical microscope. Studied the subdermal vascular network , identified the primary supplying arteries, investigated anatomic characteristics, distribution, origin and perforation sites of these arteries, measured lengths and diameters of these arteries and branches. Arteries of nasolabial groove region were examined radiographically in one fresh cadaver that had been injected with 38% cardiografin through external carotid artery, observed the characteristics, distribution of the supplying arteries in the nasolabial groove region. The clinical study included 25 patients (15 males and 10 females) in a 2-year period, the patients ranged in age from 23 to 71 years with a mean age of 39 years. 25 cases of subcutaneous island nasolabial flap were designed on anatomic basis and used for the reconstruction of nasal partial defects, the size of the defects varied from 2.0 cm×1.5cm to 3.5 cm×3.0cm.The size of the flap varied from 2.5 cm×1.5cm to 6.5 cm×3.0cm. The survival rate of the flap, the stability, aesthetic and functional outcomes of the reconstructed nose were followed up. Results The nasolabial groove region was mainly supplied by the branches of facial artery, infraorbital artery, angular artery and transverse facial artery, The branches diverging from these arteries became superficial and formed a subcutaneous arterial network, the arteries from the network went to the corium layer and formed a subepidermal arterial network whose arteries anastomosed with each other in a honeycomb-like structure. The vascular distribution presented certain directivity on different areas. The blood supply of the subcutaneous island pedicle nasolabial flap depends basically on the subdermal arterial network that formed by the perforator branches of the facial artery, infraorbital artery, angular artery, transverse facial artery. The blood supply of the pedicle originate from the perforator branches of any one of these arteries, the pedicle could locate any site of the nasolabial groove region. All flaps survived completely except one with blister on the flap which healed spontaneously, During 3-12 months of clinical follow-up after the operation,the aesthetic and functional results of each case were satisfactory by patients and surgeon. Conclusions The nasolabial groove region was mainly supplied by the branches of facial artery, infraorbital artery, angular artery and transverse facial artery. The blood supply of the subcutaneous island pedicle nasolabial flap depends basically on the subdermal arterial network that formed by the perforator branches of the facial artery, infraorbital artery, angular artery and transverse facial artery, the blood supply of the pedicle originated from the perforator branches of any one of these arteries, the pedicle could locate any site of the nasolabial groove region. The subcutaneous island pedicle nasolabial flap is ideally suitable and extremely good one-step procedure for the reconstruction of nasal partial defects, provides an excellent choice for cosmetic and functional reconstruction of the nasal partial defect. It is simple, dependable and easy to harvest flap that can repair the nasal partial defects.