Vascular Perfusion of the Facial Skin - Implications in Allotransplantation of Facial Aesthetic Subunits.

BACKGROUND: As the field of face transplantation develops, it may be possible to transplant segments of facial skin to replace facial aesthetic subunits in selected cases. The aim of this study is to identify the more reliable vascular pedicles of each facial aesthetic subunit for its use in transplantation METHODS: Six full-facial soft tissue flaps were harvested and the external carotid arteries were identified and cannulated proximally to the facial arteries (FA). Next, radiopaque contrast was injected through the facial arteries in three of the facial flaps and though the superficial temporal arteries (STA) in the other three facial flaps. Following vascular injections, three-dimensional computed tomographic arteriographies of the faces were performed allowing analysis of the arterial anatomy and perfusion in different facial aesthetic subunits. RESULTS: The chin, lower lip, upper lip, medial cheek, nose and periorbital units were perfused in all facial flaps where the FA was injected and in none of those injected by the STA. The lateral cheek was perfused in 100% of the STA flaps and in 66% of the FA flaps .The lateral forehead contained contrast in 100% of the STA injected flaps and in none of the FA injected flaps and the medial foreheads contained contrast in 66% of the FA injected flaps and in 66% of the STA flaps. CONCLUSION: The majority of the facial subunits can be harvested based on the FA pedicle with the exception of the lateral forehead that is based on the STA. (C)2016American Society of Plastic Surgeons

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