Summary
Background
Functional and aesthetic reconstruction of severe facial deformities presents a major
challenge, and the results are rarely satisfactory. Recent clinical success of composite
tissue allograft transplantation and improvements in autoimmune regulation have initiated
efforts to reconstruct severe facial deformities with alloplastic tissue. Few reports
address the full facial flap dissection approach, where lengthy procedural times remain
a limiting factor in achieving optimal graft survival. Extensive vascular anastomoses
within facial tissues provide a unique opportunity to explore alternative graft harvesting
strategies to optimise operative ischaemia.
Objective
The aim of the study was to shorten donor-graft harvesting time and reduce warm ischaemia.
We evaluated alternative facial harvesting strategies through mock cadaveric facial
transplantations.
Methods
Cadaveric dissections were performed to explore facial-scalp reconstruction alternatives.
Six paired sub-superficial muscloaponeurotic system (SMAS) plane composite facial-scalp
flaps were harvested using either a superficial temporal artery (STA) or a facial
artery (FA) pedicle technique (Group I) or an external carotid artery (ECA) pedicle
technique. Total harvesting times and lengths of vascular pedicles were measured.
Results
Harvesting time for a STA and FA pedicle total facial flap (mean=113 min, range=105–120 min, SD=6 min) was shorter than that for an ECA pedicle flap (mean=232 min, range=225–240 min, SD=6 min) (P<0.01). Mean pedicle lengths for the STA, the FA, the ECA, the external jugular vein,
and the facial vein were 37±2.1, 35±1.8, 26±1.4, 52±3.0 and 42±2.6 mm, respectively. Mean pedicle lengths for the supraorbital, supratrochlear, infraorbital,
mental, and facial nerve were 15±1.5, 14±1.4, 24±1.2, 30±1.6 and 32±1.8 mm, respectively.
Conclusion
Compared with previously reported ECA pedicle total facial allograft harvesting techniques,
an STA and FA pedicle flap provides a shorter harvesting time and potentially safer
dissection method for facial transplantation by avoiding interference with the complicated
anatomy of the carotid and submental triangle. Early graft ischaemic damage can be
minimised by this harvesting technique, which significantly shortens harvesting time
compared with previously described approaches, while maintaining adequate full facial
perfusion.
Keywords
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Article info
Publication history
Published online: August 15, 2007
Accepted:
June 25,
2007
Received:
June 25,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
