Zhou Wei-Na, Wan Lin-Zhong, Zhang Ping, Yuan Hua, Jiang Hong-Bing, Du Yi-Fei
Assistant Professor, Jiangsu Key Laboratory of Oral Diseases and Department of Polyclinic Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
Associate Professor, Jiangsu Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
J Oral Maxillofac Surg. 2017 Mar;75(3):649.e1-649.e10. doi: 10.1016/j.joms.2016.11.018. Epub 2016 Nov 26.
Facial artery perforator flaps (FAPFs) are preferred for the repair of intraoral and peri-nasal defects because it is a convenient procedure with minimal donor-site morbidity. The purpose of this study was to investigate the anatomic features of FAPFs and present their clinical application in intraoral reconstruction.
Five cadaver specimens (10 sides) of the head and neck region and 90 clinical cases (90 sides) of neck dissection were analyzed to explore the facial venous drainage system of FAPFs. In addition, anatomic features of the facial artery and vein and the marginal mandibular branch of the facial nerve were investigated in cadaver specimens. Furthermore, the authors reviewed a series of 33 intraoral reconstruction cases using their designed FAPFs focusing on flap survival and facial venous drainage system types.
Based on cadaveric and clinical observations, the facial vein drainage system was divided into 3 types: type A drained into the internal jugular vein (47%); type B drained into the external jugular vein (37%); and type C drained into the anterior jugular vein (16%). The mean distances from the facial artery to the vein at the region of the FAPF pedicle and tip were 2.79 ± 0.51 and 10.24 ± 0.70 mm, respectively. Most cases using the authors' designed FAPFs yielded satisfactory esthetic and functional outcomes, whereas 3 cases presented with venous congestion from type C facial vein drainage.
This study improved the understanding of the anatomic features and clinical application of FAPFs in intraoral reconstruction. This FAPF design could be used to achieve superior intraoral defect reconstruction, and type C facial vein drainage might be a risk factor for flap survival.
面动脉穿支皮瓣（FAPFs）因操作简便且供区并发症少，常用于修复口腔内及鼻周缺损。本研究旨在探讨面动脉穿支皮瓣的解剖学特征，并介绍其在口腔内重建中的临床应用。
分析5例头颈部尸体标本（10侧）及90例颈部清扫临床病例（90侧），以探究面动脉穿支皮瓣的面部静脉引流系统。此外，在尸体标本上研究了面动脉、静脉及面神经下颌缘支的解剖学特征。另外，作者回顾了一系列33例使用其设计的面动脉穿支皮瓣进行口腔内重建的病例，重点关注皮瓣存活情况及面部静脉引流系统类型。
基于尸体及临床观察，面部静脉引流系统分为3种类型：A型汇入颈内静脉（47%）；B型汇入颈外静脉（37%）；C型汇入颈前静脉（16%）。在面动脉穿支皮瓣蒂部和尖端区域，面动脉与静脉的平均距离分别为2.79±0.51和10.24±0.70毫米。大多数使用作者设计的面动脉穿支皮瓣的病例获得了满意的美学和功能效果，而3例出现了C型面部静脉引流导致的静脉淤血。
本研究增进了对面动脉穿支皮瓣在口腔内重建中的解剖学特征及临床应用的理解。这种面动脉穿支皮瓣设计可用于实现出色的口腔内缺损重建，C型面部静脉引流可能是皮瓣存活的一个危险因素。
