Imaging Study Of Perforator Vessels In Face And Retrospective Clinical Application

Objective: In order to better ensure the safety of the perforator flap in the repair of large facial defects,this study designed a facial ultrasound imaging study to record the diameter of the facial perforator,the maximum blood flow velocity and the distance from the detection point to the body surface.We also designed two clinical studies.One is to compare the clinical efficacy of free skin grafting and flap transplantation in repairing large facial defects.The second is the method and clinical effect of using multi-source blood supply angular perforator flap to repair large area facial soft tissue defects caused by various reasons.Methods:(1)Imaging study of facial perforator vessels : 3 healthy volunteers without facial diseases were selected.The facial perforator vessels were detected by color Doppler ultrasound.The diameter of the perforator,the maximum blood flow velocity and the distance from the detection point to the body surface were detected.(2)Clinical study on the comparison of the efficacy of free skin grafting and multi-source blood supply angular perforator flap transplantation in the repair of large facial defects : Patients with facial defects admitted to the Department of Plastic Surgery,the First Affiliated Hospital of Anhui Medical University from June 2015 to July 2021 were selected.When using the angular perforator flap with multi-source blood supply,according to the size of the wound,the relaxation of the surrounding skin,the distance from the distal end of the wound to the selected perforator flap pedicle and the reference to the Langer ’s line,the tip of the angular perforator flap is about the width of the defect,and the length is about 3.0-3.5 times the width of the defect.The patients were followed up for 1 year.The flap or skin graft survival rate,Vancouver scar scale(VSS)score,quality of life score and patient satisfaction were recorded and compared between the two groups.Results:(1)Imaging study of facial perforator vessels : The average diameter of the perforators detected on the face was 0.058 ± 0.030 cm,the maximum blood flow velocity was 25.4 ± 5.1cm / s,and the distance between the detection point and the body surface was 0.274 ± 0.084 cm.Clinical study on the comparison of the efficacy of free skin graft and multi-source blood supply angular perforator flap transplantation in repairing large facial defects :After 1 year of follow-up,the average flap survival rate of the perforator flap transplantation group was 99.67 ± 0.90 %,and the average skin graft survival rate of the free skin graft group was 97.80 ± 3.93 %.There was no significant difference between the two groups(P = 0.084).The VSS score of the flap transplantation group was 4.47 ±1.73,and the VSS score of the free skin graft group was 6.33 ± 1.91.The difference between the two groups was statistically significant(P = 0.009).There was no significant difference in the quality of life score between the two groups before operation(P = 0.484).The quality of life score of the flap transplantation group was81.65 + 3.69 at 1 year after operation,and the quality of life score of the free skin graft group was 71.28 + 5.09.The difference between the two groups was statistically significant(P = 0.0001).The patient satisfaction of the flap transplantation group was100.00 %,while that of the free skin grafting group was 66.67 %.The difference between the two groups was statistically significant(P = 0.042).Conclusion: Our results showed that there was no significant difference in the efficacy of multi-source blood supply angular perforator flap transplantation for repairing large facial defects compared with free skin grafting,but it could significantly improve the scar appearance of the surgical area.The angular perforator flap with multi-source blood supply is suitable for repairing large-area soft tissue defects in the face.The curative effect is stable,and the shape and function are satisfactory.It is especially suitable for repairing large-area soft tissue defects left after resection of facial skin malignant tumors in middle-aged and elderly patients.