Vascular Basis of the Facial Artery Perforator Flap: Analysis of 101 Perforator Territories

Background: The facial artery perforator flap was developed to perform more accurate reconstruction of perioral and nasal alar defects. This technique allows tailor-made reconstruction and shifting from the traditional two-stage procedure to a one-stage technique. Cadaveric studies have described the number, location, and size of facial artery perforators. Understanding of the facial artery blood supply can be complete, however, only if the cutaneous supply of each perforator is known. Methods: The authors performed 20 dissections of facial arteries on fresh cadavers. All facial artery perforators greater than 0.5 mm were dissected and the diameters measured. All perforators were selectively injected with 1 ml of diluted ink solution. All these results were statistically analyzed. Results: Twenty facial arteries were dissected, with a mean length of 12.06 cm. The average number of perforators greater than 0.5 mm per facial artery was 5.05. The mean diameter of the perforators was 0.96 mm. A total of 101 perforators were selectively injected, and the mean size of all injected skin areas was 8.05 cm(2). Seven main, reliable types of perforator territory were identified. Conclusions: Facial artery perforators seem to be predominantly between 1 and 2 cm lateral to the level of the oral commissure. Seven main types of perforasomes have been identified and appear to be the basis for local flap design. This study improves our understanding of facial vascularization and will allow the face to give up the era of random flaps to take advantage of more accurate reconstructions from the rest of the body. (Plast. Reconstr. Surg. 129: 421, 2012.)