title: The facial artery perforator flap for reconstruction of perioral defects.
abstract: BACKGROUND
  The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap.
  
  
  METHODS
  Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators.
  
  
  RESULTS
  Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis.
  
  
  CONCLUSIONS
  The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation and an aesthetically pleasing donor site. The thin pedicle makes it an ideal flap for one-stage reconstruction without secondary revisions.
authors.affiliation: Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center Rotterdam, The Netherlands. s.hofer@erasmusmc.nl
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Posch
authors.forename: Xander
authors.initials: X
authors.lastname: Smit
mesh_terms: D000368:Aged; D001158:Arteries / Q000033:anatomy & histology; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002610:Cheek; D004210:Dissection; D005145:Face / Q000098:blood supply; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008048:Lip Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply