Supratrochlear Artery (Off-Midline) Forehead Skin Flap

EDITORIAL COMMENT

The robust blood supply to the forehead does not necessitate the inclusion of a distinct vessel. However, more attention should be paid to the anatomic and visual units of the nose. Often, the best result is obtained by reconstructing the entire aesthetic unit of the nose, even if it requires excising normal tissue.

A forehead flap that is located to one side of the midline and that extends to the hairline recess can be based on one supratrochlear artery (1, 2, 3, 4).

ANATOMY

The supratrochlear artery is a branch of the ophthalmic artery, and it leaves the orbit at its superomedial aspect. In the forehead, it runs vertically, accompanied by its vein, into the hairline recess.

FLAP DESIGN AND DIMENSIONS

The base of the flap, that includes the supratrochlear vessels, is at the orbital margin, near the medial end of the eyebrow. The carrier segment is between 0.5 and 1.0 cm wide. When the flap is turned to cover nasal defects, the pivot point is at the lateral side of the base, and the flap arcs through 180°. The length of the flap depends on the height of the browline and the depth of the hairline recess. The paddle is designed to fit the defect and can be “flagged” to one side of the carrier segment. The position of the paddle is determined by the hairless skin available on either side of the vessels (Fig. 54.1).

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