Facial Artery Perforators Research Articles

Hotspots of facial artery perforators and perforasomes for easier flap guidance: An anatomical study

BackgroundThe facial artery perforator flap is a valuable alternative for reconstruction of small to medium defects in the central midface and provide pleasing cosmetic results, allowing reconstruction in a one-stage procedure. Since Doppler ultrasound is not applicable to distinguish perforator from source artery, anatomical studies are needed to identify perforator areas along the course of the facial artery. MethodsTwenty facial arteries of 10 fresh anatomical head specimens were dissected. All perforators with an outer diameter of at least 0.50 mm were identified and injected with dye to color their respective vascular territories. Size and location of colored skin territories as well as the location of its perforators were documented and statistically analyzed. ResultsIn total, 89 perforators were identified. The average number of perforators per facial artery was 4.45±1.15. The mean outer diameter of the perforator at the origin of the facial artery was 0,65±0.14 mm. The mean size of the colored skin territories was 577.57±488.81 mm2. Perforator diameters were significantly associated with the size of its resulting perforasomes. Furthermore, perforators mostly originated in two specific areas: 3.5 cm lateral and caudal and 4.5 cm lateral and 5.5 cm caudal of the anterior nasal spine. ConclusionThis study provides evidence of two predominant locations of emergence of facial artery perforators. Additionally, the significant correlation between perforator size and its appendant perforasomes as well as their location with reference to the anterior nasal spine as relevant osseous landmarks helps surgeons in decision making for flap design and surgery.

Perforasomes of the facial artery

BackgroundThe facial artery perforator flap is a valuable alternative for reconstruction of small to medium defects in the central midface. Not only does it provide pleasing cosmetic results, it also allows reconstruction in a one‐stage procedure. Even though facial artery perforators have been examined by anatomical studies during the past years, there is still little knowledge of the vascular territories provided by these vessels. Aiming to make facial artery perforator flaps a plannable and safer procedure, this study examines the location and size of the vascular territories provided by facial artery perforators.Material and methods20 facial arteries of fresh specimen have been dissected. All perforators with an external diameter of at least 0,50 mm have been identified and injected with Methylene blue‐ or Eosin Y‐solutions to color their appendant vascular territories. All colored skin territories have been photographed, digitalized and measured. Their location, as well as the location of the perforating vessels, has been shown. All results were statistically analyzed.Results95 perforators with an external diameter of at least 0,50 mm have been identified. The average number of perforators per facial artery was 4,75. The mean external diameter at the origin of the facial artery was 0,64 ± 0,14 mm. The mean size of the colored skin territories was 5,62 ± 4,83 cm2. There was a statistical correlation between perforator diameter and the size of its vascular territory.ConclusionTwo areas have been shown in which facial artery perforators originate frequently. Their location has been described in relation to a bone structure. Size and shape of the vascular territories show a high variability with regions of increased density. The graphical illustration of the location of the facial artery perforators and their vascular territories can help making facial artery perforator flaps a better plannable procedure.

A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction

ObjectiveThe purpose of this study was to introduce submandibular-facial artery island flaps (S-FAIF), including the perforator flap, and to evaluate their application for intraoral reconstruction in comparison with submental artery perforator flaps (SMAPF). MethodsNinety-six patients who underwent intraoral reconstruction using an S-FAIF (n = 34) or SMAPF (n = 62) after cancer resection were recruited in this study. The flap characteristics (viz., pedicle length, flap size, venous drainage pattern, and harvest time), short-term outcomes (viz., flap partial loss, intraoral wound dehiscence, fistula, and wound infection), and long-term morbidity (viz., facial nerve palsy, neck motion restriction, and hair growth) were compared. ResultsNine S-FAIFs were authentic perforator flaps pedicled by level Ⅰ facial artery perforators, while the rest were island flaps based on level Ⅱ facial artery perforators. The survival rates of S-FAIF and SMAPF were both 100 percent. Flap partial loss occurred in two patients in each group. The pedicle length of S-FAIF was shorter than that of SMAPF (p < 0.001). Statistics analysis revealed no significant difference regarding flap size, venous drainage pattern, short-term outcomes, neck motion restriction, or facial nerve palsy between the groups. S-FAIF required less harvest time (p < 0.001) and experienced less hair growth when compared to SMAPF (p = 0.011). ConclusionsThe S-FAIF is a robust and reliable novel flap and on par with SMAPF for reconstruction of small and medium-sized intraoral defects. It is preferred to SMAPF when technical requirements for flap harvest and hair problems are considered. It should be supplemented to the armamentarium for intraoral reconstruction.

Transverse Facial Artery Perforators: Anatomical, Two- and Three-Dimensional Radiographic Study.

Increased anatomical knowledge of skin vascularization, such as the recent description of angiosome and perforasome concepts, has led to important innovations in flap surgery. In this sense, few studies have been performed on face vascularization especially for facial artery perforasomes. The aim of this study was to analyze the number, size, and localization of transverse facial artery perforators and their perfusion area. Fourteen hemifaces of fresh adult cadavers from the Department of Anatomy of Lyon University were harvested. Transverse facial artery perforators were identified, dissected, cannulated, and selectively injected with 1 ml of patent blue or contrast solution. Photography, microangiography, and computed tomography were performed. Perforator diameter and localization from the lateral canthus were measured. Exact topography and size of the perforasome were analyzed. Twenty-three transverse facial artery perforators were identified. Mean perforator diameter was 1.01 ± 0.3 mm. Mean perforating site was 31.0 ± 8.0 mm lateral to and 38.7 ± 8.8 mm below the lateral canthus. Mean single perforasome surface area was 25.3 ± 18.34 cm and mean transverse facial artery skin territory was 40.5 ± 9.78 cm. The transverse facial artery provides at least one perforator that can be accurately localized using a Doppler probe. Clinical applications related to the improved knowledge of transverse facial artery perforators could be as follows: (1) performing a lateral facial skin flap; (2) facial composite allotransplants; (3) face-lift procedures to improve skin perfusion; and (4) prevention of vessel injury in aesthetic procedures such as dermal filler injection or thread-lift techniques.

Nasolabial propeller perforator flap: Anatomical study and case series.

The previous cadaveric studies of facial artery perforators have frequently reported high variability, and those results remain to be validated in the Colombian population. Thus, we aimed to describe the vascular anatomy of the lateral nasal artery cutaneous branches and their clinical applications using Colombian cadavers. Nine hemifaces from six fresh cadavers were included in the study. Terminal branches of the facial artery and cutaneous perforators of the lateral nasal artery were dissected. The quality, number, and distribution of the perforators were assessed. In addition, we present results of seven clinical cases for nasal alar reconstruction. Cutaneous perforators were found in all hemifaces, and zone 2 was the most common location. In our clinical case series, all flaps used to reconstruct the nasal alar defects survived. There were two cases of venous congestion but no additional procedures were needed. Although nasal alar reconstruction continues to be a challenging plastic surgery procedure, the nasolabial propeller perforator flap is an excellent choice for such because it allows a precise skin island design, is less bulky, has a wide arc of rotation, and facilitates one-staged reconstruction without increasing the rate of complications.

Progress of anatomic research and clinical application of facial artery perforator flap

To summarize the present status and progress of the anatomy researches and clinical application of the facial artery perforator flap (FAPF). The relative researches focused on the anatomy researches and clinical application of FAPF were extensively reviewed, analyzed, and summarized. The facial artery perforator (FAP) has constant anatomy. There are more facial artery perforators in the perioral region, and each FAP has two accompanying veins. Distinguished by inferior mandibular border, the upper and the lower flaps both are used for reconstruction of defects on the face. The most widely-used upper flap was FAPF, which is excellent choice of defects in mid-face. Additionally, angular artery perforator flap and lateral nasal artery perforator flap are becoming more and more popular. While submental artery perforator flap, whose pedicle locates under inferior mandibular border, is most used for reconstruction of lower face. FAPF for face defect repair can achieve good outcomes of function and appearance in clinical application. Based on multiple advantages of good aesthetics and function outcomes, high survival rate, flexible design, and simple operation, FAPF is an optimal choice for defect repair of perioral region and nasal ala. However, Further study is needed to determine whether retaining tissue around the pedicle will affect vein reflux of the flap.

Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications.

BackgroundPrevious studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators.MethodsSixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects.ResultsThe mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures.ConclusionsNasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.

Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application.

The concept of the facial artery perforator flap was developed for improved freedom during the reconstruction of perioral and perinasal defects. This flap enables tailor-made reconstruction and a shift from the traditional two-stage procedure to a one-stage technique. In this cadaveric study, the authors quantify the number, length, and diameter of facial artery perforators (FAPs) and present their clinical experience with the FAP flap. The authors performed 20 dissections of facial arteries (FAs). All FAPs greater than 0.5mm were dissected to study the number, length, and diameter of FAPs. In addition, the authors report a case series of 15 perinasal defect reconstruction procedures performed using facial artery-based perforator flap. A total of 125 FAPs were dissected. We identified a mean of six FAPs per hemiface (range five to eight). The average length of all FAPs was 17.6±1.9mm, and the mean diameter of the FAPs was 0.91±0.2. Fifteen patients underwent a perinasal defect reconstruction using a FAP flap with good aesthetic and functional results. The following study thus improves our understanding of FAP anatomy and clinical application and will enable the nasolabial fold to become the area where perinasal defect reconstruction using perforator flaps is performed.

Perforator flaps of the facial artery angiosome

For small to moderate-sized defects in the head and neck region, local flaps have been the mainstay of reconstruction for years. However, in certain instances, additional flap translation is required be it advancement, transposition or rotation. In such cases, the local flap concept is combined with perforator flap know-how, allowing larger loco-regional flaps to be raised to reconstruct relatively larger defects, even in cosmetically-expensive areas. In our cohort of fifteen patients', we have utilised detailed microanatomy of the facial artery perforators to reconstruct such defects with good results.

Vascular Basis of the Facial Artery Perforator Flap

The facial artery perforator flap was developed to perform more accurate reconstruction of perioral and nasal alar defects. This technique allows tailor-made reconstruction and shifting from the traditional two-stage procedure to a one-stage technique. Cadaveric studies have described the number, location, and size of facial artery perforators. Understanding of the facial artery blood supply can be complete, however, only if the cutaneous supply of each perforator is known. The authors performed 20 dissections of facial arteries on fresh cadavers. All facial artery perforators greater than 0.5 mm were dissected and the diameters measured. All perforators were selectively injected with 1 ml of diluted ink solution. All these results were statistically analyzed. Twenty facial arteries were dissected, with a mean length of 12.06 cm. The average number of perforators greater than 0.5 mm per facial artery was 5.05. The mean diameter of the perforators was 0.96 mm. A total of 101 perforators were selectively injected, and the mean size of all injected skin areas was 8.05 cm. Seven main, reliable types of perforator territory were identified. Facial artery perforators seem to be predominantly between 1 and 2 cm lateral to the level of the oral commissure. Seven main types of perforasomes have been identified and appear to be the basis for local flap design. This study improves our understanding of facial vascularization and will allow the face to give up the era of random flaps to take advantage of more accurate reconstructions from the rest of the body.

The need for a complete platysma component for platysma myocutaneous flaps?-an introduction of the expanded cutaneous-dominant platysma flap for facial defect reconstruction

Platysma flaps have been successfully used for the reconstruction of variety of facial defects as musculocutaneous. This concept had been changed by a recent anatomical investigation revealing the inherently fasciocutanous nature of the platysma flap. In the study, it was observed that all of the arterial branches furnishing the anterlateral neck skin penetrate the platysma but do not run along in the platysma layer. The switch made it possible for us to design cervical skin flaps with limited participation of muscular platysma composition in clinical practice. The platysma flap is considered to be an ideal donor source due to its thin, pliable and sufficient colour matched skin nature. When combined with the tissue expansion technique, this flap can provide adequate donor tissue that is particularly valuable for large facial defect repairs without leaving any modalities on the neck donor site. In our report, we designed and used the expanded platysma myocutaneous flap as a cutaneous-dominant skin flap for large facial defect repairs. In operation, the cervical flap is elevated at the intermediate layer between the platysma and the superficial adipofascia. A small amount platysma muscular tissue is recruited only in the area surrounding these facial artery perforators at the flap peddle region. As anticipated, the result was successful. We conclude that the expanded cutaneous-dominant platysma flap peddled by facial artery perforators provides a useful alternative for the reconstruction of facial defects and should be a valuable addition to facial reconstructive surgery.

Where to find facial artery perforators: A reference point

Reconstructive surgery of the midface using facial artery perforator (FAP) flaps is being used more frequently now as it has been reported to provide better aesthetic results and reduce a traditional two-stage procedure to a one-stage technique. However, the wide acceptance of this approach is limited by a poor understanding of the anatomy associated with this technique. This was investigated through a cadaveric study. The facial artery (FA) of 16 cadaveric half-faces were each identified, cannulated with coloured latex and then dissected to give an accurate and quantified description of FA perforating branches. A lateral-view picture of each specimen was taken and analysed using ImageJ 1.42q. Cadaveric dissections showed that each hemiface could be regarded as a single entity. The values of the means were as follows: FA length=116±22 mm, FA diameter=2.62±0.74 mm, number of FAPs=4±2, FAP length=14.12±3.46 mm and FAP diameter=0.94±0.29 mm. A reference point, A, where FAPs were consistently found to originate, was also identified. Therefore, the FAP flap is a viable and valuable addition to plastic reconstructive techniques. The localisation of point A with precise measurements can facilitate the design and use of such FAP flaps for the reconstruction of nasal, as well as perinasal and perioral defects.

Reconstruction of the perioral and perinasal defects with facial artery perforator flaps

Perioral and perinasal regions are important aesthetic subunits of the face. Numerous traditional flaps supplied by the facial artery are well known and have widespread use in these regions. Elevation of these flaps based on the perforator branches of the facial artery can make them more mobile, reliable and adaptable. This report presents the authors' experience using a facial artery perforator flap in the reconstruction of perioral and perinasal defects. Twelve clinical cases with 14 perioral and perinasal skin defects resulting from malignant or benign skin tumour excision were reconstructed using facial artery perforator flaps. Surgical technique was planned by adhering, as much as possible, to the principle of aesthetic unit for facial reconstruction. The donor-site scars were designed parallel to the facial wrinkles when possible. As an adjunct procedure, a lower lip buccal mucosal V-Y advancement flap was used in some patients who had defects that included lower lip mucosa. In all cases, favourable cosmetic and functional results were obtained with a single-stage procedure that did not require secondary revisions. The aesthetically pleasing donor site based on the facial artery perforators offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.

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 cutaneous blood supply of the neck: relevance to incision planning and surgical reconstruction

Previous descriptions of the blood supply of the neck have been contradictory. Neck dissections were performed on 17 adult cadavers after perfusion with radio-opaque microfil silicone rubber compound. In four cadavers cervical incisions were created and flaps elevated prior to perfusion to help demonstrate vascular pathways.In all cadavers myocutaneous perforators were seen passing from the sternocleidomastoid, strap muscles, and trapezius to supply the dermal-subdermal plexus. Also, there were consistently identifiable branches of the superior thyroid, posterior auricular, occipital, facial and transverse cervical arteries, which supply both the platysmal vascular plexus and the overlying dermal-subdermal plexus. The dermal-subdermal plexus is continuous across the midline and this contralateral pathway is supplied chiefly from branches of the superior thyroid artery, facial artery, and myocutaneous perforators of the strap muscles. This information may be useful in the planning of cervical incisions and the design of platysma myocutaneous flaps.