Experimental study of the facial artery: relevance to its reverse flow competence and cutaneous blood supply of the neck for clinical use as a new flap.

Abstract

The reconstruction of a midfacial soft tissue defect is still challenging. Identification of a regional flap of adequate size and pedicle is required for one-stage reconstruction to be achieved. The purpose of this study was to prove the efficacy and reliability of a skin island flap nourished by a submental branch of the facial artery, using the distal facial artery as a pedicle in a reverse-flow fashion. The skin territory nourished by the submental branch of the facial artery was demonstrated by selective injection of methylene blue into the relevant vessel in eight fresh cadavers. Adequacy of the reverse flow was studied by monitoring the intra-arterial pressure of the distal facial artery in ten patients undergoing neck dissection before and after ligation of the proximal facial artery and manual occlusion of the contralateral facial artery. For the methylene blue study, the injected dye invariably stained the upper two-thirds of the neck skin from the anterior border of the sternocleidomastoid muscle to the midline of the neck. For the reverse-flow study, there was no significant change in the mean intra-arterial pressure in the facial artery after proximal ligation and occlusion of the contralateral relevant artery. This new flap was applied successfully to four patients. This new flap, named "reverse facial cervical flap" is reliable for reconstructing midfacial soft tissue and oropharyngeal defects.