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 ± 22 mm, FA diameter = 2.62 ± 0.74 mm, number of FAPs = 4 ± 2, FAP length = 14.12 ± 3.46 mm and FAP diameter = 0.94 ± 0.29 mm. 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.