Facial subdermal vascular network flap: anatomic study and clinical application

Abstract

Despite the numerous flaps for facial reconstruction that have been described, the search for the ideal flap with good color matching and minimal donor-site morbidity continues. In the past 3 years we have repaired 13 facial defects with success using the lateral genicervical flap - a type of facial subdermal vascular network flap (SVNF) - with a pedicle located on the preauricular region. An anatomic study of the facial SVNF, including blood supply and vascular distribution of the face and anatomic characteristics of facial vessels, based on 14 cadaver dissections, was carried out. The blood supply of the facial skin basically originated from the branches of the facial, superficial temporal and infraorbital arteries. The lateral genicervical skin was supplied basically by the branches of the facial, superficial temporal and occipital arteries, but also by the terminal branches of the superior thyroid artery. The branches diverging from these arteries became superficial and formed a subcutaneous arterial network. The arterioles from the network went to the corium layer and formed a subdermal arterial network whose arterioles anastomosed with each other in a honeycomb-like structure. The vascular distribution presented certain directivity on different areas. The blood supply of the pedicle originated from the subdermal vascular network formed by the perforator branches of these arteries. The arterioles from the facial and superficial temporal arteries anastomosed in the lateral genicervical region. From the anatomic study, we think that the viability of the facial SVNF depends basically on the subdermal vascular network formed by the perforator branches of the pedicle, and that the anastomoses between the facial and superficial temporal arteries provide a solid anatomic basis to the lateral genicervical flap. The clinical data also indicated that this flap is a useful alternative for facial, especially superficial temporal, defects. But the directivity must be taken into account in its clinical application.

The Infraorbital Artery in Fetuses: Clinical Relevance in Perforator Flap Surgery

“…Conversely if the labial point is dominant, the transverse-maxillary system becomes more significant. Xiong et al suggested that the vascular distribution has certain directivity on different areas ( 1 ). For instance, in the middle of face the vessels run horizontally from ear to nose; in the frontal region, blood vessels are distributed vertically in inferior to superior direction; and in the mental region, the vessels run obliquely from the mandibular margin to internal superior (nose).…”

“…However, three blood vessels are dominant in the arterial supply of the skin of the face. These are facial, superficial temporal and infraorbital artery ( 1 ). Perforator branches of latter cited arteries might be used as vascular stalks of numerous flaps which could be used for the facial soft tissue defects reconstruction ( 2 ).…”

Transdermal optical imaging revealed different spatiotemporal patterns of facial cardiovascular activities

“…This assumption, however, is not true 3 , 16 , 17 . It is now well established that the facial vascular distribution is highly heterogeneous due to the unique network of facial vascular system and differential neural controls by the sympathetic and parasympathetic nervous systems 18 , 19 . In agreement with this view point, Ghiass et al ., using another optical imaging method (i.e., infrared imaging), also extracted a vascular network that is heterogeneously distributed across faces 20 , 21 .…”

Structural Characterization and Anticomplement Activity of an Acidic Heteropolysaccharide from Lysimachia christinae Hance

“…It has been reported that Hedyotis diffusa polysaccharide with in vitro anticomplement activity could inhibit LPS induced overactivation of complement system in mice by oral administration [9]. Additional study revealed that intravenous injection of Houttuynia cordata polysaccharide was ineffective, while oral administration exerted the therapeutic effect [10]. Considering the large molecular weight of polysaccharide, oral administration is safe and effective, which provides ideas for the subsequent study of the mechanism of anticomplement activity of LCP-90-1 in vivo through oral administration.…”