[Composite midfacial flap vascularized by the facial artery: a preliminary anatomic study]

Extended facial tissue defects are difficult to reconstruct because of the anatomical and functional complexity of the area. Recently, composite facial allotransplantation was used for reconstruction. This could be performed because of specific facial blood supply and its facial and maxillary anastomoses. Could a composite naso-labio-mental flap rely on the sole blood supply of a facial artery anastomosis? We performed an anatomic study of a naso-labio-mental composite flap vascularized by the facial artery.

The study relied on arteriographies made on cadaveric heads and in vivo. The following data was analyzed: caliber of facial and maxillary arteries, terminal branch of facial arteries, and vascular territories.

Sixteen facial arteries and six maxillary arteries were studied. The mean facial artery caliber was 2.06 mm (1-3.2mm). The facial artery ended in the nasal area in 68.8% of the cases. The latero-nasal artery was always present; it was a branch of the facial artery in 66.7% of cases. The two facial arteries, when injected bilaterally, always allowed complete facial composite flap circulation. The nasal territory of the flap was not opacified by the homolateral facial artery in 16.7% of the cases.

Both facial artery anastomoses are recommended as blood supply for composite midfacial flaps. Preoperative imaging should be used systematically to assess the vascular network before harvesting.