COMPARISON OF FLAP VASCULAR ANATOMY IN 3 RHYTIDECTOMY TECHNIQUES

The purpose of this study was to examine differences in blood supply t o facial flaps created by three rhyditectomy techniques. The technique s chosen for comparison included a two-layer technique, consisting of separate subcutaneous and extended submuscular aponeurotic system (SMA S) dissections, the Composite dissections as described by Hamra, and a subperiosteal dissection. Six cadavers were injected with lead oxide before dissection, and eight were injected after dissection. After all owing the lead oxide to set, the soft tissues were removed from the fa ce. Vascular patterns of the face were interpreted from x-rays taken o f the specimens. Results of the injections performed before dissection confirmed contributions of previously described arteries, including t he transverse facial, facial, infra-orbital and terminal branches of t he ophthalmic. In addition, there are numerous branches that connect t hese Vessels to each other. The most consistent of these include the m asseteric, jugal, submental, labial, angular and nasal arteries. The p atterns of communications between these vessels allow for the visualiz ation of three vertically oriented vascular zones, each connected to t he nest by choke zones where anastomoses occur. Dissections performed before injection reveal increased filling of the vessels through more of the flap on the Composite side when compared with the two-layered d issection, absence of vessels in the SMAS, and filling across all thre e zones on the subperiosteal side. We conclude that there are vascular regions in the face connected by anastomotic choke zones. Separate su bcutaneous and sub-SMAS dissections interrupt the vascular connection between zones. Arterial continuity is better maintained in the Composi te lift and is literally undisturbed in the subperiosteal lift. These findings may help to explain why extreme tension applied to the Compos ite flap during closure is so well-tolerated and why extended subcutan eous dissection places the skin at risk for ischemic necrosis. Finally , the SMAS may contain a separate vascular supply, but this supply is probably tenuous and easily compromised after extensive dissection.