Achieving ideal surgical outcomes by identifying the dominant supratrochlear artery for forehead flap harvesting: A comparative study

Despite being considered the golden standard for nasal reconstruction for decades, there has been a lack of detailed investigation into the hemodynamic differences between bilateral supratrochlear vessels during forehead flap procedures. In this study, the authors utilized infrared thermography (IRT) to identify the dominant supratrochlear vessel as the nourished pedicle, aiming to achieve optimal surgical outcomes. A total of 24 regular and 40 pre-expanded forehead flaps, consecutively included from October 2017 to February 2023, were retrospectively divided into two groups for analysis. In group A (11 regular and 23 pre-expanded flaps), bilateral supratrochlear arteries were identified using infrared thermography (IRT) and color Doppler ultrasound (CDU), with the flap designed based on the dominant side. In group B (13 regular and 17 pre-expanded flaps), the flap was designed directly at the ipsilateral side. Vascular disparities and surgical outcomes were compared. Among the 34 flaps in group A, bilateral hemodynamic disparities were observed in 13 flaps (38.2 %), comprising of 3 regular flaps (27.2 %) and 10 pre-expanded flaps (43.5 %). The complication incidences for group A is lower than that for group B (5/34 VS 9/30, p < 0.05). The complication rate between regular and pre-expanded flaps was 3/24 versus 11/40, p < 0.05. All complications resulted in a delayed pedicle division. The potential asymmetry of supratrochlear arteries could significantly impact the prognosis of nasal reconstruction with forehead flaps, especially within tissue expansion technique. It is essential to identify the dominant side to achieve optimized surgical outcomes.