Anatomical Basis And Clinical Application Of Repairing Facial Defects With The Perforator Flap Of Midface

OBJECTIVE: To dissect the facial artery,superficial temporal artery anterior cutaneous branch,and infraorbital artery of midface,to understand the walking and branching conditions,and to explore clinical effects of repairing facial defects with the facial artery,superficial temporal artery,prefrontal pedicle,infraorbital artery perforator flap.METHODS:(1)A study was made by dissecting 5(10 sides)fresh adult cadavers,were injected with red latex solution from the distal end of common carotid artery.The skin of the relevant area was sharply peeled,and part of the subcutaneous tissue was removed.From the lower edge of the mandibular to the entire process of the medial malleolus,sacral,infraorbital anatomic artery,superficial temporal artery,and infratemporal artery.(2)Between October 2015 and January 2018,clinical application of the facial artery,submental artery,superficial temporal artery perforator flap to repair 46 cases of facial defects,including 28 cases of basal cell carcinoma,6 cases of pigmented nevus,scales 12 cases of cystic carcinoma.The skin lesion was about 1.0cm×2.0cm~4.0cm×6.0cm in size.During the operation,the tumor tissue was resected and sent for intraoperative frozen pathological examination,suggested that the edge and the base were negative.According to the shape,size,basement,and position of the residual wound surface,In combination with the source of blood supply,perforation of the facial skin and the flaps,designed to repair the wounds by means of pedicle flaps of the medial arterial perforator branch,either alone or in combination.Among them,28 were designed to cut the facial arterial perforator flap,18 in the superficial temporal artery anteversion perforator flap,and 18 in the submental artery perforator flap.The flap area was 1.5cm×3.0cm~3.5cm×7.5cm and the pedicle length was1.0~3.5cm.RESULTS: The facial artery entered the face upwards from the anterior edge of the chewing muscle around the lower edge of the mandible,advanced upwards to approximately 1 cm from the ostium of the mouth,delivered a constant perforator lateral to the mouth,then rose to the base of the alar,and reached the inner apex along the lateral side of the nose.Continuation of the angular artery.There is a rich anastomotic branch with the dorsal nasal artery and infraorbital artery.The superficial temporal artery anterior perforator of the superficial temporal artery is a constant branch of the superficial temporal artery in front of the tragus.It is derived from the middle branch of the superficial branch of the superficial temporal artery or the trunk of the superficial temporal artery and travels independently.It supplies the anterior ear and the front of the ear.The skin and subcutaneous tissue of the lower area.The infrapatellar artery originates from the maxillary artery and an infraorbital hole is located below the midpoint of the infraorbital margin.After exiting the fistula,first walk between the upper lip and the levator palpebrae,then turn to the outside and lift between the upper labrum and zygomatic muscle.The terminal branch distributes in the lower and middle part of the oculi.The lips,lacrimal sac,and the lateral side of the nose,etc.,together with the small blood vessels from the facial artery and facial transverse artery constitute a subcutaneous vascular network.Clinical application of facial artery,superficial temporal artery anterior perforator branch,submental artery pedicled perforator flap repair 46 cases of facial defects,flaps survived in one stage,good shape after surgery;one case of facial artery perforator flap There was bruising in the distal part and delayed healing after treatment with acupuncture and hemorrhage.The patient survived for 2 months to 1 year.The flap survived well and there was no dysfunction.Six months later,a linear scar remained,and the texture and thickness of the flap remained.Moderate,the same color as normal skin,the appearance is satisfactory.Conclusion: The facial artery,superficial temporal artery,tragus perforator,and infratemporal artery are basically stable on the face and have constant perforation,but there is a certain variation in anatomy.Clinically designed to cut the midface facial artery perforator flap,submental artery perforator flap,superficial temporal artery tragus perforator flap to repair the cheek,lower eyelid,underarm,ankle,nose and surrounding tissue In the case of a defect,the exploration of the medial arterial artery should be performed before surgery to increase the success rate of flap extraction.The defect was repaired in one stage,and good functional and esthetic repair was obtained after the operation.