Use of the Distal Facial Artery (Angular Artery) for Supermicrosurgical Midface Reconstruction

Hidehiko Yoshimatsu, MD; Mitsunobu Harima, MD; Takuya Iida, MD; Mitsunaga Narushima, MD; Ryo Karakawa, MD; Shuichi Nakatsukasa, MD; Takumi Yamamoto, MD; Akitatsu Hayashi, MD

doi:10.1097/GOX.0000000000001978

Plastic and Reconstructive Surgery, Global Open (Feb 2019)

Use of the Distal Facial Artery (Angular Artery) for Supermicrosurgical Midface Reconstruction

Hidehiko Yoshimatsu, MD,
Mitsunobu Harima, MD,
Takuya Iida, MD,
Mitsunaga Narushima, MD,
Ryo Karakawa, MD,
Shuichi Nakatsukasa, MD,
Takumi Yamamoto, MD,
Akitatsu Hayashi, MD

Affiliations

Hidehiko Yoshimatsu, MD: From the *Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Mitsunobu Harima, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Takuya Iida, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Mitsunaga Narushima, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ryo Karakawa, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Shuichi Nakatsukasa, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Takumi Yamamoto, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Akitatsu Hayashi, MD: †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

DOI: https://doi.org/10.1097/GOX.0000000000001978
Journal volume & issue: Vol. 7, no. 2
p. e1978

Abstract

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Background:. In free-flap reconstruction of the midface, options for the recipient artery are quite limited; the superficial temporal artery and the facial artery are the most commonly used arteries. We report our approach for the use of the angular artery (the terminal branch of the facial artery) as the recipient artery in free-flap reconstruction of the midface. Methods:. Nine patients with midface defects underwent free-flap reconstructions using the angular artery as the recipient artery. Identification and marking of the facial artery were performed preoperatively using handheld Doppler ultrasound. The angular artery was located through an incision made on the side of the nose. When present, a vena comitans of the facial artery or any subcutaneous vein in the vicinity of the defect was used as the recipient vein. In other cases, the facial vein in the submandibular region was chosen as the recipient vein, using a vein graft. Results:. The average diameter of the angular artery was 0.9 mm (range, 0.7–1.0 mm). In all cases, arterial anastomosis was performed in an end-to-end fashion, and flaps survived completely. In 4 cases, a vein graft was used to bridge the pedicle vein and the facial vein. Conclusions:. Although supermicrosurgical skills may be required for its anastomosis, the angular artery is an anatomically consistent artery, which is suitable for use as the recipient artery in free-flap reconstruction of the midface. Use of the angular artery as the recipient artery allows shorter flap pedicles and decreases the number of vein grafts necessary.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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