The anatomic basis for the design of forehead flaps in nasal reconstruction.

The detailed arterial anatomy of the medial forehead region was evaluated using roentgenographic examinations of injected cadaver heads, anatomic dissections of injected cadaver heads, and Doppler examination of normal subjects. The supratrochlear artery was seen to be the dominant artery of the medial forehead (not the supraorbital). The supratrochlear artery exited the orbit 1.7 to 2.2 cm from the midline, passing superficial to the corrugator and deep to the orbicularis and frontalis muscles. The supratrochlear artery then passes just medial to the eyebrow and pierces the frontalis muscle, ascending the rest of the forehead in a subcutaneous plane 1.5 to 2.0 cm from the midline (paramedian position). The implications of this vascular anatomy on forehead flap design and execution for nasal reconstruction are discussed and clinical cases are presented.