Infraorbital Artery Perforator Flap: A Viable Option for Facial Defect Reconstruction Clinical Case Analysis and Preliminary Anatomical Study.

backgroundReconstruction of central facial regions, particularly the lower eyelid and lateral nasal areas, continues to pose significant challenges for plastic surgeons. These regions encompass multiple esthetic subunits, necessitating meticulous consideration of texture compatibility and tension-free closure within each unit. Although various perforator flaps-such as those based on the facial artery or supraorbital artery-have been employed for mid-cheek reconstruction, achieving optimal contour and esthetic integration of the periorbital and nasal subunits remains difficult. In this study, we investigate the application of an infraorbital artery (IOA) perforator flap for the reconstruction of the lower eyelid and lateral nasal region, aiming to improve postoperative esthetic outcomes.

methodsThis study provides an anatomical description and its clinical applications. In a cadaveric study, eight hemifaces were used to illustrate the precise location of the IOA, and the flap and artery pedicle were dissected to confirm surgical feasibility. Between August 2022 and May 2024, four patients underwent surgery with IOA perforator flaps to repair their lower eyelid or nose.

resultsAnatomical Study: In anatomical dissections, the mean distance between the infraorbital artery (IOA) and the infraorbital rim was 10.12 ± 1.10 mm, while the mean diameter of the IOA at its origin from the infraorbital foramen measured 1.50 ± 1.09 mm. During the dissection of the IOAP and its accompanying nerves, the mean diameter of the perforating vessels was approximately 0.5 mm. The length of the vascular pedicle that could be mobilized ranged from 2 to 4 cm. CLINICAL STUDY: In the clinical series, four patients underwent reconstruction with an IOA perforator flap. All flaps survived without signs of necrosis or vascular compromise, indicating excellent flap viability and reliable perfusion. According to the FACE-Q assessment scale, patients showed significant improvements in both esthetic appearance and functional outcomes.

conclusionsThe infraorbital artery perforator flap represents a feasible and effective option for the reconstruction of defects involving the nose and lower eyelid, offering superior contour restoration of the periorbital and nasal regions compared to alternative techniques. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .