Facial Artery Perforator Research Articles

Free style facial artery perforator flap for one stage reconstruction of the nasal ala

The nasolabial skin is the ideal donor site for nasal ala reconstruction. The classic techniques involve a two-stage procedure to reconstruct an aesthetically pleasing nasal ala. A one-stage technique for reconstruction of the nasal ala with a free style nasolabial perforator flap is presented in this article. The technique has been used in eight patients between November 2004 and June 2007. In most of the cases (seven out of eight) the whole alar subunit was reconstructed. Besides a small distal 2mm necrosis in one flap--which healed without further treatment--all the flaps healed uneventfully with aesthetically pleasing results using the one-stage technique. The free style perforator nasolabial island flap has become the method of choice in the authors' institution for nasal ala reconstruction, especially when the defect involves the whole subunit. It allows one-stage reconstruction with very similar tissue and a concealed scar in the natural groove.

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

Perforator Flaps in Head and Neck Reconstruction

This article attempts to put perforator flaps, as they apply to head and neck reconstruction, into perspective. The importance of existing flaps is emphasized. Specific indications for perforator flaps are highlighted. The deep inferior epigastric artery perforator flap is used as the flap of choice for subtotal glossectomy defects by the authors. The anterolateral thigh flap is the most common flap currently used. Indications for its use are highlighted. Facial artery perforator flaps are introduced, and their roles as local flaps in head and neck reconstruction are highlighted. With our better understanding of vascular anatomy, existing flaps such as the submental flap have been recategorized as perforator flaps. Its role in reconstruction, particularly of lower facial defects, is discussed. Finally the internal mammary artery perforator flap is described and its advantages over the deltopectoral flap and the pectoralis major flap outlined.

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap. Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators. Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis. The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation and an aesthetically pleasing donor site. The thin pedicle makes it an ideal flap for one-stage reconstruction without secondary revisions.

The contribution of the SMAS to the blood supply in the lateral face lift flap.

The purpose of this study was to compare the arterial blood supply of the lateral face lift flap when the flap is elevated either above or below the SMAS. The transverse facial artery supplies blood to a large portion of the lateral face lift flap. This vessel passes through the superficial musculoaponeurotic system (SMAS) in its course toward the flap. The transverse facial artery is at risk for transection during both elevation of the skin flap and elevation of the SMAS. Nine fresh cadavers underwent a single-plane rhytidectomy either superficial to the SMAS or in a sub-SMAS plane. In half the subjects, the transverse facial artery perforator was identified prior to dissection using surface landmarks and preserved. In the other half of dissected specimens, this perforator was transected by undermining through the transverse facial artery perforation site (near the zygomatic ligament). This transection is typically performed during a face lift. The facial artery and transverse facial artery were selectively injected with ink, and cutaneous staining was recorded. It was found that the pattern and total area of ink staining occurred in an all-or-none fashion depending on whether the transverse facial artery had been preserved or transected. Inclusion or exclusion of the SMAS layer in the dissected lateral face lift flap had no effect on the ink injection pattern, suggesting that the SMAS plays little or no role in lateral face lift flap viability.