Where to find facial artery perforators: a reference point☆

Reconstructive surgery of the midface using facial artery perforator (FAP) flaps is being used more frequently now as it has been reported to provide better aesthetic results and reduce a traditional two-stage procedure to a one-stage technique. However, the wide acceptance of this approach is limited by a poor understanding of the anatomy associated with this technique. This was investigated through a cadaveric study. The facial artery (FA) of 16 cadaveric half-faces were each identified, cannulated with coloured latex and then dissected to give an accurate and quantified description of FA perforating branches. A lateral-view picture of each specimen was taken and analysed using ImageJ 1.42q. Cadaveric dissections showed that each hemiface could be regarded as a single entity. The values of the means were as follows: FA length=116±22mm, FA diameter=2.62±0.74mm, number of FAPs=4±2, FAP length=14.12±3.46mm and FAP diameter=0.94±0.29mm. A reference point, A, where FAPs were consistently found to originate, was also identified. Therefore, the FAP flap is a viable and valuable addition to plastic reconstructive techniques. The localisation of point A with precise measurements can facilitate the design and use of such FAP flaps for the reconstruction of nasal, as well as perinasal and perioral defects.