Schaverien Mark V, Pessa Joel E, Saint-Cyr Michel, Rohrich Rod J
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2009 May;123(5):1581-1587. doi: 10.1097/PRS.0b013e3181a20544.
Studies of the vascularity of the superficial musculoaponeurotic system (SMAS) have suggested that it is an avascular layer. Clinical studies, however, suggest that the incidence of skin slough is higher in subcutaneous face lift dissections. A reappraisal of the arterial and venous supply of the face lift flap using sequential dye injection studies and three-dimensional computed tomographic imaging techniques may help to further elucidate the mechanisms behind vascular complications following rhytidectomy.
Studies were performed on 24 hemifaces from fresh cadavers. In six heads, injection with a barium sulfate/gelatin mixture was performed followed by three-dimensional computed tomographic angiography and venography. Four heads underwent arterial and venous injection with colored latex followed by dissection studies. Sequential dye injection studies were performed in two heads following isolation and cannulation of the transverse facial artery and elevation of a composite (sub-SMAS) rhytidectomy flap followed by subcutaneous dissection. Dye injection studies were also performed through the external carotid artery before and after ligation of the transverse facial artery.
The most significant arterial contribution to the lateral face lift flap was from the transverse facial artery perforator. Arteries contributed branches to the SMAS on their way to the dense subdermal plexus, forming a continuous anastomotic network. The SMAS was devoid of veins, but the superficial venous system was found arranged in a polygonal configuration at the level of the subdermal plexus. Sequential dye injection studies following dissection in a composite then subcutaneous plane with preservation of the transverse facial artery perforator revealed reduced perfusion of the preauricular skin following dissection in the subcutaneous plane.
The composite face lift flap revealed better perfusion in the preauricular region compared with a subcutaneous dissection, although much of this area is routinely excised during rhytidectomy. The lateral face lift flap is perfused predominantly by the transverse facial artery perforator, and its ligation results in reduction of perfusion in the preauricular region. These findings may have relevance in patients with vascular compromise.
对表浅肌肉腱膜系统（SMAS）血管分布的研究表明它是一个无血管层。然而，临床研究提示皮下除皱术剥离中皮肤坏死的发生率更高。采用序贯染料注射研究和三维计算机断层成像技术对面部提升皮瓣的动脉和静脉血供进行重新评估，可能有助于进一步阐明除皱术后血管并发症背后的机制。
对24侧新鲜尸体半侧面部进行研究。在6个头部，注射硫酸钡/明胶混合物，随后进行三维计算机断层血管造影和静脉造影。4个头部进行动脉和静脉彩色乳胶注射，随后进行解剖研究。在2个头部，在分离并插管颞浅动脉及掀起复合（SMAS下）除皱皮瓣后进行皮下剥离，然后进行序贯染料注射研究。在结扎颞浅动脉前后，也通过颈外动脉进行染料注射研究。
对侧面部提升皮瓣最主要的动脉供血来自颞浅动脉穿支。动脉在通向致密的皮下静脉丛途中向SMAS发出分支，形成一个连续的吻合网络。SMAS没有静脉，但发现浅静脉系统在皮下静脉丛水平呈多边形分布。在保留颞浅动脉穿支的情况下，先在复合平面然后在皮下平面进行剥离后的序贯染料注射研究显示，皮下平面剥离后耳前皮肤灌注减少。
与皮下剥离相比，复合面部提升皮瓣在耳前区域显示出更好的灌注，尽管在除皱术中该区域大部分会被常规切除。侧面面部提升皮瓣主要由颞浅动脉穿支供血，结扎该动脉会导致耳前区域灌注减少。这些发现可能与有血管受损的患者有关。
