Anatomical Study and Clinical Application of Facial Artery Perforator Flaps in Intraoral Reconstruction: Focusing on Venous System

Abstract

Facial artery perforator flaps (FAPFs) are preferred for the repair of intraoral and peri-nasal defects because it is a convenient procedure with minimal donor-site morbidity. The purpose of this studywas to investigate the anatomic features of FAPFs and present their clinical application in intraoral reconstruction. Five cadaver specimens (10 sides) of the head and neck region and 90 clinical cases (90 sides) of neck dissection were analyzed to explore the facial venous drainage system of FAPFs. In addition, anatomic features of the facial artery and vein and the marginal mandibular branch of the facial nerve were investigated in cadaver specimens. Furthermore, the authors reviewed a series of 33 intraoral reconstruction cases using their designed FAPFs focusing on flap survival and facial venous drainage system types. Based on cadaveric and clinical observations, the facial vein drainage system was divided into 3 types: type A drained into the internal jugular vein (47%); type B drained into the external jugular vein (37%); and type C drained into the anterior jugular vein (16%). The mean distances from the facial artery to the vein at the region of the FAPF pedicle and tip were 2.79 ± 0.51 and 10.24 ± 0.70mm, respectively. Most cases using the authors' designed FAPFs yielded satisfactory esthetic and functional outcomes, whereas 3 cases presented with venous congestion from type C facial vein drainage. This study improved the understanding of the anatomic features and clinical application of FAPFs in intraoral reconstruction. This FAPF design could be used to achieve superior intraoral defect reconstruction, and type C facial vein drainage might be a risk factor for flap survival.