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An Anatomical Study of External Carotid Artery Vascular Territories in Face and Midface Flaps for Transplantation

Banks, Nia D. M.D., Ph.D.; Hui-Chou, Helen G. M.D.; Tripathi, Satyen M.A.; Collins, Brendan J. M.D.; Stanwix, Matthew G. M.D.; Nam, Arthur J. M.D.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic and Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - p 1677-1687
doi: 10.1097/PRS.0b013e3181a3f3ae
Experimental: Original Articles

Background: The technical success of facial composite tissue allotransplantation demands full understanding of superficial and deep perfusion for reliable microvascular transfer. Candidates with composite midface defects require an appreciation of the circulatory patterns to design a composite midface allotransplant.

Methods: External carotid vascular territories were evaluated in 10 cadavers to determine the reliability of facial soft-tissue flaps based on a single vascular pedicle. The right common carotid artery was injected with red latex and the left was injected with blue latex. Dual perfusion was confirmed by purple, following two-color mixing. Vascular pedicles included the superficial temporal, transverse facial, and facial arteries. In five additional cadavers, the midface segment was isolated by Le Fort III osteotomy after two-color latex injection with inclusion of the internal maxillary vascular pedicle. Cadavers were imaged with three-dimensional computed tomographic reconstructions following latex injection to confirm perfusion patterns.

Results: In soft-tissue facial flaps, unilateral carotid dominance was seen in the nasal dorsum and tip, confirming reliable supply by a single external carotid artery. In midface flaps, bilateral perfusion was seen in the maxilla. Ipsilateral perfusion was observed at the zygomaticomaxillary complex without any contralateral contribution.

Conclusions: Dual soft-tissue perfusion was confirmed in most specimens at the nasal, central face, and maxilla. The inclusion of the maxilla in the design of a facial composite allotransplant demands bilateral vascular pedicles based on the internal maxillary arteries. The authors highlight a procurement strategy for design of such flaps.

Baltimore, Md.

From the University of Maryland R Adams Cowley Shock Trauma Center and the Johns Hopkins University School of Medicine.

Received for publication September 19, 2008; accepted December 2, 2008.

Disclosure: None of the authors has a financial interest to declare in relation to the content of this article.

Eduardo D. Rodriguez, M.D., D.D.S., R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, Md. 21201,

©2009American Society of Plastic Surgeons