Letter to the Editor on “Modified Supratrochlear Artery Forehead Island Flap: A Novel Approach for 1-Stage Reconstruction of Nasal Defects”

Dear Editor-in-Chief,

We have read with great interest the article titled “Modified Supratrochlear Artery Forehead Island Flap: A Novel Approach for 1-Stage Reconstruction of Nasal Defects.” ¹ It details the successful reconstruction of nasal defects in a 49-year-old patient with squamous cell carcinoma using a modified supratrochlear artery forehead island flap. We highly appreciate the innovative approach presented by the authors. However, we have some viewpoints regarding certain details and would like to engage in a deeper discussion.

First, we noticed that the patient had a high hairline, which might have served as an advantage for the implementation of this surgical technique. For patients with relatively low hairlines, we deem it necessary to adjust surgical approaches or undertake appropriate preoperative preparations to achieve optimal surgical outcomes.

Second, in the frontal view postoperative images of the patient, noticeable swelling is observed at the nasion, the site where the subcutaneous tunnel of the supratrochlear artery island flap transfers. Based on personal clinical experience, this swelling may be somewhat correlated with the slightly greater angle of rotation of the flap. It is hypothesized that selecting the flap donor site on the contralateral side would decrease the rotation angle of the flap, thereby increasing its survival rate and reducing postoperative swelling.

Third, the midline central artery forehead flap has been reported in the literature as a successful method for repairing larger nasal defects. ² In my opinion, this flap could also achieve the desired reconstructive outcome, with the advantage of lesser postoperative swelling in the flap rotation area. ³ Of course, various factors need to be considered by surgeons during flap transplantation, such as vascular supply, aesthetics, simplicity, and risk of flap necrosis.^4-6

In conclusion, we greatly appreciate the author’s innovative spirit in designing a modified flap for 1-stage repair of a large nasal defect. The presentation of this case suggests that this novel technique can serve as a reliable 1-stage surgical approach for nasal defect reconstruction. We look forward to witnessing more of the author’s contributions in the future.