Reconstruction of the perioral and perinasal defects with facial artery perforator flaps

Abstract

Perioral and perinasal regions are important aesthetic subunits of the face. Numerous traditional flaps supplied by the facial artery are well known and have widespread use in these regions. Elevation of these flaps based on the perforator branches of the facial artery can make them more mobile, reliable and adaptable. This report presents the authors' experience using a facial artery perforator flap in the reconstruction of perioral and perinasal defects. Twelve clinical cases with 14 perioral and perinasal skin defects resulting from malignant or benign skin tumour excision were reconstructed using facial artery perforator flaps. Surgical technique was planned by adhering, as much as possible, to the principle of aesthetic unit for facial reconstruction. The donor-site scars were designed parallel to the facial wrinkles when possible. As an adjunct procedure, a lower lip buccal mucosal V-Y advancement flap was used in some patients who had defects that included lower lip mucosa. In all cases, favourable cosmetic and functional results were obtained with a single-stage procedure that did not require secondary revisions. The aesthetically pleasing donor site based on the facial artery perforators offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.