Whetzel T P, Stevenson T R
Division of Plastic and Reconstructive Surgery, University of California, Davis, Medical Center, Sacramento, USA.
Plast Reconstr Surg. 1997 Sep;100(4):1011-8. doi: 10.1097/00006534-199709001-00027.
The purpose of this study was to compare the arterial blood supply of the lateral face lift flap when the flap is elevated either above or below the SMAS. The transverse facial artery supplies blood to a large portion of the lateral face lift flap. This vessel passes through the superficial musculoaponeurotic system (SMAS) in its course toward the flap. The transverse facial artery is at risk for transection during both elevation of the skin flap and elevation of the SMAS. Nine fresh cadavers underwent a single-plane rhytidectomy either superficial to the SMAS or in a sub-SMAS plane. In half the subjects, the transverse facial artery perforator was identified prior to dissection using surface landmarks and preserved. In the other half of dissected specimens, this perforator was transected by undermining through the transverse facial artery perforation site (near the zygomatic ligament). This transection is typically performed during a face lift. The facial artery and transverse facial artery were selectively injected with ink, and cutaneous staining was recorded. It was found that the pattern and total area of ink staining occurred in an all-or-none fashion depending on whether the transverse facial artery had been preserved or transected. Inclusion or exclusion of the SMAS layer in the dissected lateral face lift flap had no effect on the ink injection pattern, suggesting that the SMAS plays little or no role in lateral face lift flap viability.
本研究的目的是比较在颞浅筋膜（SMAS）上方或下方掀起皮瓣时，面外侧提升皮瓣的动脉血供情况。面横动脉为面外侧提升皮瓣的大部分区域供血。该血管在走向皮瓣的过程中穿过颞浅筋膜系统（SMAS）。在掀起皮瓣和掀起SMAS的过程中，面横动脉都有被横断的风险。对9具新鲜尸体进行了单平面除皱术，分别在SMAS浅面或SMAS下平面进行。在一半的受试者中，在解剖前利用体表标志识别出面横动脉穿支并予以保留。在另一半解剖标本中，通过在面横动脉穿支部位（靠近颧韧带）进行潜行剥离将该穿支横断。这种横断操作通常在面部提升术中进行。对面动脉和面横动脉进行选择性墨汁注射，并记录皮肤染色情况。结果发现，根据面横动脉是被保留还是被横断，墨汁染色的模式和总面积呈现出全或无的方式。在解剖的面外侧提升皮瓣中包含或不包含SMAS层对墨汁注射模式没有影响，这表明SMAS在面外侧提升皮瓣的存活中作用很小或没有作用。
