The Freestyle Facial Artery Perforator Flap for Reconstruction of Simultaneous Periorbital and Cheek Defects

Abstract

The reconstruction of defects involving the nasolabial, paranasal, and periorbital regions may be challenging, because they often involve more than one facial aesthetic unit, and can lead to functional problems. An average of 5 facial artery perforators of caliber >0.5 mm can be found above the mandible. A reference point for the location of the most constantly encountered perforator was suggested as being 1.5 cm lateral to the oral commissure, and at its same level in height or slightly inferior to the commissure. Based on injection studies, it is known that these perforators can supply an average area of 8 cm. The authors have extended the use of the freestyle perforator flap in a 87-year-old woman presented with an advanced melanoma of the paranasal area and nasolabial region (Breslow depth: 9 mm; Clark level V). Complete resection of the lesion with 3 cm oncological margins was performed. One-stage reconstruction with superior cosmetic results was achieved. The need for a perforator dissection is not necessarily a drawback, and classic concerns should be abandoned. The face is highly vascularized, and flap congestion is a rare event, usually a consequence of excessive pedicle trimming. Although technically more demanding, it should become one of the first reconstructive options when dealing with similar defects, if our results are confirmed in larger series.

Three-Dimensional Computed Tomography of the Detoured Facial Artery: Variations and Implications for Nasojugal Groove Correction

“…This high presence of the nasolabial trunk can provide an effective blood supply to the nasolabial island flap during facial reconstructive surgery. [17][18][19][20][21][22][23] The current data provided the first detailed and complete understanding of the 3D topography and distribution of the detoured facial artery through the use of dissection, CT scanning, and Mimics 3D reconstruction. The 3dimensional location of the detoured facial artery as reported here will help clinicians to avoid iatrogenic damage when they are implementing nonsurgical procedures for nasojugal groove rejuvenation.…”

“…This high presence of the nasolabial trunk can provide an effective blood supply to the nasolabial island flap during facial reconstructive surgery. 17–23…”

The facial artery perforator flap for intraoral reconstruction of a mouth floor defect

“…Propeller facial artery perforator flaps were suggested by Ruiz‐Moya et al () for nasolabial and perinasal complex defects. We also described the application of a free style facial artery perforator for reconstruction of simultaneous periorbital and cheek defects (Horta, Teixeira, Nascimento, Silva, & Amarante, ).…”

Approach to Reconstruction of Cheek Defects

“…The facial artery perforator flap has shown promise for the reconstruction of cheek, paranasal, 19 periorbital, 20 and oral 20 defects. Centered on a thin perforator, the flap has a wide rotation arc and excellent mobility, permitting application in a wide variety of defects.…”

“…The flap is typically centered on the constant facial artery perforator, located 1.5 cm lateral to the oral commissure. 19 This ensures a reliable vascular supply, as the five facial artery perforators constitute the major vascular supply of the cheek. Dissection of the perforator commences in the subcutaneous plane until little soft tissue is present around the perforator.…”