Whetzel T P, Mathes S J
Division of Plastic and Reconstructive Surgery, University of California Davis Medical Center, Sacramento, Calif.
Plast Reconstr Surg. 1997 Aug;100(2):480-6; discussion 487-8. doi: 10.1097/00006534-199708000-00033.
The cutaneous arterial circulation of the face lift flap was investigated using multiple anatomic techniques in fresh cadaver specimens. Perforation sites of the transverse facial and submental arteries were preserved or transected according to protocol during bilateral rhytidectomy prior to selective injections with ink or lead oxide. It was observed that the transverse facial perforating artery provides the major direct blood supply to the lateral cheek and preauricular area following rhytidectomy if preserved. This perforator occupies a constant anatomic location 3.1 cm lateral and 3.7 cm inferior to the lateral canthus with 95 percent tolerance limits of +/-1.1 cm. There is greater variability in localizing the submental perforating artery; however, this perforator also contributes significantly to lateral facial blood supply. Both perforator locations are within the area of "standard" undermining for rhytidectomy; however, they may be preserved during this procedure if desired. Transection of the lateral facial perforators leaves vascularization of these cutaneous areas dependent on collateral flow from the pedicle of the face lift flap. The ability to preserve optimal blood supply to the lateral face lift flap may be useful in the clinical setting of a vascularly compromised or smoking patient.
采用多种解剖技术在新鲜尸体标本中研究了除皱皮瓣的皮肤动脉循环。在双侧除皱术前，按照方案在选择性注入墨水或氧化铅之前，保留或横断面横动脉和颏下动脉的穿支部位。观察到，如果保留面横穿支动脉，除皱术后它为颊外侧和耳前区域提供主要的直接血液供应。该穿支位于外眦外侧3.1 cm、下方3.7 cm处的恒定解剖位置，95%的耐受限度为±1.1 cm。颏下穿支动脉的定位变异性更大；然而，该穿支对面部外侧血液供应也有显著贡献。两个穿支的位置均在除皱术“标准”潜行分离的区域内；然而，如果需要，在该手术过程中可以保留它们。横断面部外侧穿支会使这些皮肤区域的血管化依赖于除皱皮瓣蒂部的侧支血流。在血管受损或吸烟的患者的临床情况下，保留对面部外侧除皱皮瓣的最佳血液供应的能力可能是有用的。
