Brussels, Belgium.
From the Pôle de Morphologie, Institut de Recherche Expérimentale et Clinique, and the Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain; and the Department of Plastic and Reconstructive Surgery, Université catholique de Louvain-Cliniques Universitaires St-Luc.
Plast Reconstr Surg. 2018 Mar;141(3):751-761. doi: 10.1097/PRS.0000000000004116.
In the field of vascularized composite tissue allotransplantation, the surgical design of facial subunit grafts is an evolving concept. The purpose of the present article is to study the possibility of dividing the historical nose and lip face transplant into several morphologic and functional subunit grafts, depending on their respective supply.
This study was conducted in 20 adult cadavers. The facial artery and its branches were dissected bilaterally in 16 fresh and four embalmed heads. Nasolabial perfusion was assessed by selective injection of methylene blue and eosin (n = 2) or India ink (n = 2) in the superior labial and distal facial arteries. Dynamic perfusion through the distal facial artery was illustrated by fluoroscopy (n = 3). Three nose-upper lip grafts were harvested and injected with barium sulfate for microangiography computed tomographic analysis. Finally, three isolated nasal and bilabial grafts were procured and their vascular patency assessed by fluoroscopy.
The distal facial artery can perfuse the entire nose, septum, and upper lip, without any contribution of the superior labial artery. A dense anastomotic network indeed exists between the respective distal rami of both vessels. Furthermore, the exclusion of the superior labial artery from the harvested nasal subunit allowed safe bilabial subunit procurement, from the same specimen.
The authors' results demonstrate the feasibility of harvesting nasal and labial subunits, in an isolated or a combined manner. These results can find applications in subunit autologous replantation, allotransplantation, allogenic face partial retransplantation, and the emerging field of vascularized composite tissue engineering.
在血管化复合组织同种异体移植领域，面部分区移植物的外科设计是一个不断发展的概念。本文旨在研究根据各自的供应情况，将历史上的鼻和唇面部移植分为几个形态和功能的亚单位移植物的可能性。
本研究在 20 具成人尸体上进行。16 个新鲜头颅和 4 个防腐头颅双侧解剖面动脉及其分支。通过选择性注射亚甲蓝和曙红（n=2）或印度墨（n=2）于上唇动脉和远端面动脉评估鼻唇灌注。通过透视（n=3）显示远端面动脉的动态灌注。采集 3 个鼻上唇移植物并注入硫酸钡进行微血管造影计算机断层分析。最后，采集 3 个分离的鼻和唇移植物并通过透视评估其血管通畅性。
远端面动脉可以灌注整个鼻子、鼻中隔和上唇，而无需上唇动脉的任何贡献。实际上，这两支血管的远端分支之间存在密集的吻合网络。此外，从采集的鼻亚单位中排除上唇动脉可以安全地从同一标本中获取唇亚单位。
作者的结果证明了以单独或组合方式采集鼻和唇亚单位的可行性。这些结果可以应用于亚单位自体再植、同种异体移植、同种异体面部部分再移植以及新兴的血管化复合组织工程领域。
