In perforator flaps, anastomosis between flap and recipient vessels in the neck area is often difficult due to small vessel diameter and short pedicle. The aim of this study was to investigate whether the retrograde flow of the distal, paramandibular part of the facial artery would provide sufficient pressure and size to perfuse perforator flaps. Before and after occlusion of the contralateral facial artery, retrograde and anterograde arterial pressure was measured on both sides of the facial artery in 50 patients. The values were compared with the mean systemic arterial pressure. Diameters of facial arteries in the paramandibular region and perforator flap vessels were evaluated by morphometry. Arterial pressure in the distal facial artery with retrograde flow was 76% of the systemic arterial pressure. The latter equaled approximately the anterograde arterial pressure in the proximal end of the facial artery. Mean arterial pressure of the facial arteries decreased after proximal occlusion of the contralateral facial artery, which was not significant (P = 0.09). Mean diameter of the distal facial arteries in the mandibular region was 1.6 mm (range 1.3-2.2 mm; standard deviation 0.3 mm; n = 50), that of the perforator flap arteries 1.3 mm (0.9-2.6 mm; 0.4 mm; n = 20). Facial arteries, based on reverse flow, successfully supported all 20 perforator flaps. Retrograde pulsatile flow in the distal facial artery sustains perforator flaps even if the contralateral facial artery is occluded. Proximity of the distal facial arteries to the defect compensates for short pedicles. Matching diameters of the arteries are ideal for end-to-end anastomosis.

The standard superficial epigastric artery flap has become a reliable model for flap research. The purpose of this study was to design a flap model in the rat, with the possibility of intraoral coverage of defects. A fat flap based only on the medial trunk of the superficial epigastric vessels was generated, raised to the neck, and used for the coverage of a created intraoral defect in 28 Sprague-Dawley rats. Twenty-five epigastric flaps were raised and anastomosed to the neck, and three flaps were sutured into the oral cavity as a control without anastomosing the vessels to the rat's neck. For histological examination, each of the five flaps was harvested after 7, 14, and 35 days. A total of five rats died perioperatively, and 23 rats survived. One epigastric fat flaps became necrotic, which attracted attention by dehiscence after 3 or 4 days postoperatively, consisting of one anastomosed and all nonvascularized flaps. A swollen cheek was noted in these cases after about 5 days. Although this model demands the control of basic microsurgical techniques, it is possible to use it as a training model for further refining microsurgical techniques in flap raising. It is planned to use this flap as a model for healing purposes in the oral cavity.