Free-Style Zygomatico-Orbital Artery Propeller Perforator Flap

BACKGROUND: Despite the limitations of existing perforator flap designs, detailed descriptions of the zygomatic-orbital artery (ZOA) and its perforators remain scarce. Consequently, their clinical applications have not been adequately explored. METHODS: In our previous report, which provided an anatomic basis for understanding the ZOA and its anastomoses with surrounding arteries, we developed a distal ZOA perforator propeller flap. In this study, we expanded our focus to include all perforators, with applications extending beyond eyelid reconstruction. The propeller flap technique was used in 16 patients. The flap size ranged from 2.0×1.1 cm to 7.5×2.5 cm. RESULTS: Complications included necrosis at the distal flap margin in one patient and minor congestion at the flap tip in another, both of which healed without surgical intervention. All the other flaps survived, and no signs of disease recurrence were noted during the follow-up period (mean: 17.4 mo). All patients reported satisfactory cosmetic and functional outcomes. CONCLUSION: This study revealed the feasibility of reconstructing lateral orbit and eyelid defects with a local freestyle ZOA perforator propeller flap. The flap's reliability, versatility, and superior aesthetic outcomes make it an attractive option for surgeons, while also protecting the ZOA and temporal branches of the facial nerve.