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

Dear Editor-in-Chief,

We sincerely thank Zhang et al for their constructive feedback ¹ on our article, “Modified Supratrochlear Artery Forehead Island Flap: A Novel Approach for 1-Stage Reconstruction of Nasal Defects.” ² We appreciate the opportunity to further discuss the technique and address their valuable suggestions. Below are our responses to each comment.

First, the influence of hairline height on preoperative planning is significant. In patients with a higher hairline, a wider forehead donor area facilitates 1-stage reconstruction. This approach minimizes tissue damage while achieving optimal aesthetic results, as demonstrated in our article. By contrast, patients with lower hairline face limitations in the donor area necessitating the use of additional skin from other regions. This often involves tissue expanders or extended forehead flaps, which present challenges such as longer waiting times or cosmetic concerns, including the presence of scalp hair in the nasal region, requiring a lengthy depilation process. ³

Second, regarding the mild swelling at the nasion (the site where the supratrochlear artery pedicle turns), we agree with Zhang et al that this is likely due to the flap’s rotation angle. In this case, the rotation angle was close to 180°, increasing tissue volume at the pedicle turn. We believe that for centrally located defects, the choice between the left or right supratrochlear artery flap will not significantly impact the aesthetic outcome. However, for laterally displaced defects, we recommend using the contralateral flap to reduce the rotation angle, minimize tissue folding, and thereby improve both flap survival and aesthetic results.

Third, Zhang et al mention the midline forehead artery flap as an alternative for large nasal defects. ⁴ While it offers satisfactory reconstruction with less postoperative swelling in the flap rotation area, we selected the supratrochlear artery for its precise anatomical location and low variability, allowing for accurate identification without the need for Doppler ultrasound. ⁵ By contrast, the midline artery is subject to greater anatomical variation, increasing surgical difficulty. Further research is required to evaluate its broader applicability.

In conclusion, although our study involves a small sample size, we believe that further refinement of the modified supratrochlear artery flap technique will benefit a broader patient population in need of nasal reconstruction. We look forward to continuing our research and advancing this technique.