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Reverse flow facial artery as recipient vessel for perforator flaps
Frank Hölzle1, Bettina Hohlweg-Majert, Marco R Kesting
1Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany. hoelzle@mkg.med.tum.de
Microsurgery
|March 25, 2009
Summary
Retrograde facial artery flow offers a viable solution for head and neck perforator flap reconstruction. This reverse flow provides adequate pressure and vessel size, even when the contralateral artery is occluded.
Area of Science:
- Plastic Surgery
- Vascular Surgery
- Head and Neck Reconstruction
Background:
- Anastomosis in head and neck perforator flaps is challenging due to small vessel size and short pedicles.
- The paramandibular facial artery's retrograde flow potential for flap perfusion is not well-established.
Purpose of the Study:
- To evaluate the feasibility of using retrograde flow in the distal facial artery to perfuse head and neck perforator flaps.
- To assess the pressure, diameter, and reliability of this retrograde flow.
Main Methods:
- Measured retrograde and anterograde arterial pressure in 50 patients before and after contralateral facial artery occlusion.
- Compared pressures to mean systemic arterial pressure.
- Performed morphometric analysis of facial artery and perforator flap vessel diameters.
Main Results:
- Distal facial artery retrograde flow pressure was 76% of systemic arterial pressure, comparable to proximal anterograde pressure.
- Mean distal facial artery diameter was 1.6 mm, suitable for anastomosis with 1.3 mm perforator flap vessels.
- Retrograde flow successfully supported all 20 perforator flaps, demonstrating reliability even with contralateral occlusion.
Conclusions:
- Retrograde flow in the distal facial artery is sufficient for perfusing head and neck perforator flaps.
- The facial artery's proximity to defects and suitable vessel diameter facilitate anastomosis.
- This technique offers a reliable option for reconstructive surgery in challenging anatomical locations.
