In Response to “Supratrochlear Artery Island Paramedian Forehead Flap for Reconstructing the Exenterated Patient”

Sir,

We read with interest the article by Dr Sharma “Supratrochlear artery island paramedian forehead flap for reconstructing the exenterated patient”.¹

We suggest an alternative conclusion from this data, that is to say random-pattern pericranial flaps are able to support forehead full-thickness skin grafts. In the event of a complete orbital exenteration, the supraorbital and supratrochlear vessels are excised from the orbit and therefore do not provide any supply to the ipsilateral forehead. Vascularisation of the ipsilateral paramedian periosteal flap harvested in Dr Sharma’s technique is thus by random-pattern and not a vascular pedicle as suggested by Dr Sharma. It would be helpful if Dr Sharma could elaborate upon the positive Doppler findings in helping delineate this flap. The presence of a Doppler signal prior to dissection of this flap may have in fact arisen from the normal pericranial random vasculature including the contralateral vessels and superficial temporal arteries.²

If this is indeed the case, then perhaps the author would consider the use of a pericranial flap³ without the island of skin to line part of the orbital cavity. This lining could be surfaced with a split-thickness graft. In omitting the use of a forehead skin graft, further facial morbidity in repairing the forehead skin defect is avoided.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.