Glabellar flap technique in oculoplastic surgery

Facial skin defect reconstruction in medial?canthal area of the lids can be a challenge even when performed by a skilled surgeon. The excision of large tumors in this area leads to significant surgical defects that cannot be repaired by merely closing the wound. The glabellar area provides a source of redundant skin with similar characteristics to that of the medial?canthal lid area. The purpose show the possibility of the glabellar flap technique surgery in patients after tumor excision in the medial canthal area with the formation of a large surgical defect and especially those with defect under the medial canthal tendon. We selected 15 well?documented retrospective cases of patients operated over 2 years and followed up for a minimum of 36 months, who underwent surgery with a glabellar flap technique. Patients were operated with V?Y glabellar rotation, advancement, or combined transposition flap techniques. According to the defect’s location, we divided the patients into three groups: upper, medial, and lower surgical defects. A satisfactory functional result was obtained in all the patients. In most of them, the cosmetic results were also good. No additional surgical procedures were required in any of the patients. Our experience showed excellent results with the glabellar flap technique in all three types of lesions in the medial canthal zone— upper, medial, and especially lower which until recently was thought to be inappropriate

Clinical effects of nasal glabellar flap on reconstruction of nasal dorsal and tip / 中华医学美学美容杂志

Objective To introduce an excellent one-stage procedure for repairing defects of the middle and distal part of the nose:nasal dorsal glabellar flap.Methods According to the size,shape and location of nasal defect,homologous nasal dorsal glabellar flap was selected to cover the nasal defect in 17 cases.Among 17 cases,there were 7 men and 10 women,with age of 38 to 76 years.The locations were nasal tip in 9 cases and dorsum of nose in 8 cases,The area of the defect ranged from 15 mm× 15 mm to 30 mm× 26 mm.The nasal dorsal glabellar flap,which received a versatile axial blood supply from branches of the facial artery and ophthalmic artery,took tissue from the lax glabellar skin and might appear to be too aggressive for closure of a distal nasal or mid-nasal defect.However,because its design was primarily that of a rotation flap with a back-cut in the glabella region,it was greater than the primary defect in order to maximize tissue movement and decreased wound closure tension at the flap donor site.The secondary defect of donor site was directly sutured.Results The nasal defect was successfully repaired in all patients,and the all flaps survived.The patients were available for follow-up of 1 to 6 months,no tumor recurrence occurred,and the repaired tissue were good match with surrounding tissue in color,thickness and texture,good nasal contour was obtained and no secondary deformity occurred,and therefore the cosmetic results were satisfactory.Conclusions The nasal glabellar flap has evolved into a choice flap for nasal defects of cover since it provides local skin with an exact color,thickness,and texture match for the nasal skin.It allows large reconstructions for up to 30 mm defects leaving minimal scars.It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose.

The Vascular System of the Angular Artery: Anatomical Study and Clinical Application

PURPOSE: Although there are many ways to perform midface reconstruction, several difficulties exist for selecting the appropriate method, because of its anatomical and functional complexities, donor site morbidities, and poor aesthetic results. Various flaps based on the angular artery can overcome these limitations of the traditional reconstruction methods. The purpose of this study is to suggest an alternative reconstructive method for the midface using various flaps based on the angular artery. METHODS: We investigated the relationship 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 using island composite glabellar flap. RESULTS: The angular artery was reliable as a pedicle, whether it was used antegrade or retrograde. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The aesthetic outcomes for the donor and recipient sites were satisfactory. CONCLUSION: The angular artery has diverse relationships with its surrounding structures according to its course of travel, and if a surgeon has a precise understanding of its anatomical location, we believe that retroangular flap and island composite glabellar flap may improve the treatment of midface defects.