An Anatomical Study of External Carotid Artery Vascular Territories in Face and Midface Flaps for Transplantation

Abstract

Dual soft-tissue perfusion was confirmed in most specimens at the nasal, central face, and maxilla. The inclusion of the maxilla in the design of a facial composite allotransplant demands bilateral vascular pedicles based on the internal maxillary arteries. The authors highlight a procurement strategy for design of such flaps.

Anatomical study of the vascular territories of the maxilla: Role of the facial artery in allotransplantation

“…The maxillary artery is considered the main artery of the maxilla and the removal of these two components is considered a reliable, successful graft. 3,4 However, the artery is located deep within the tissue and is difficult to access. Instead, dissection and removal of the facial artery would be quicker and easier than the maxillary artery and could provide a valuable alternative for facial allotransplantations.…”

The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant

“…Numerous prior anatomical studies have been reported in the literature of potential transplant options for osteocutaneous transfer involving the use of the external carotid system with the internal maxillary vessels as the primary blood supply to the palate. [5][6][7][8][9][10] While the anterior wall of the maxilla can be vascularized based on the periosteal supply from the overlying soft tissue, which is supplied by the facial arterial system, the potential of the facial arterial system supplying the potential watershed area of the posterior hard palate had not previously been considered. The question remained of how much blood supply this region would get from mucosal arcades from the buccal mucosa intraorally and from Kiesselbach plexus communications to the posterior nasal vessels from the anterior nasal cavity.…”

CT Angiography for Surgical Planning in Face Transplantation Candidates

“…9,17 However, there is accumulating evidence that the facial artery can adequately perfuse both the entire maxilla and the mandible anteriorly from the insertion of the masseter muscle. 37,38 A successful, defined by improved esthetic and functional outcome after surgery, facial transplantation suggests that the facial artery alone can perfuse a midfacial allograft that includes the maxilla.…”

“…16 This concept suggests that multiple arteries are needed for perfusion of the facial skin and most of the facial skin is supplied by the superficial temporal, facial, and ophthalmic arteries. 16 However, several anastomotic networks allow perfusion of multiple adjacent territories [17][18][19][20] or across the midline. 8,9 Thus, a source artery can also perfuse neighboring angiosomes when connecting potential vessels, called "choke vessels," open, and subsequently develop into collateral vessels.…”

“…Long (15)(16)(17)(18)(19)(20)(21)(22) hours) operation times 5,6 and massive (up to 35 units) blood loss 7 have been reported. The vascular anastomoses are the most critical part of the operation.…”