Doppler-guided planning of narrow temporal skin flap based on the superficial temporal artery for large eye lid defects

Abstract

Background: The temporal area is a useful donor for flaps owing its robust blood supply from the superficial temporal artery. The anterior branch of the frontal division is one of the two terminal branches that runs antero-superiorly supplying the muscles, pericranium and skin of the lateral frontal area. Localizing the branch using Doppler enables the design of a narrow flap for eyelid reconstruction. Patients and methods: Eight patients with upper or lower eyelid defects were enrolled in the study. Doppler tracing of the anterior branch of the frontal division of the superficial temporal artery STA was done. A narrow and long flap was raised and used to reconstruct eyelid defects. Results: Three upper and five lower eyelid defects were reconstructed. Four cases were post traumatic, 2 cases were post burn and two cases were post-infection with skin loss. Seven patients had only anterior lamella defect while one female patient had full thickness lower eyelid defect which reconstructed by Hughes’ flap in addition to the forehead flap. Seven flaps healed well without any complications and one patient suffered ectropion after one month which was corrected by canthopexy.Conclusion: Doppler- guided localization of the anterior branch of frontal division of STA was beneficial in harvesting a narrow reliable flap for reconstruction of thin eyelid defects, decreased operative time and minimized donor site morbidity.