Effectiveness of Vascular Network Including Angular Artery in Inner Canthal Region for Mid-facial Reconstruction

Bae, Yong Chan; Kang, Young Seok; Hwang, So Min; Kim, Jong Hyun

Abstract

Angular artery as a terminal branch of facial artery ends at inner canthal region and anastomoses with adjacent arteries to form the vascular network in this region. Flaps using this network have been widely used to reconstruct the mid-facial defects. This study was designed to investigate the anatomical basis of theses arteries, especially angular artery which is known to have variable courses, and to demonstrate safety and effectiveness of flaps using this network. The authors reviewed several textbooks of anatomy and reported literatures through MEDLINE search about anatomy of angular artery and its anastomosis. To document clinical application, the authors also analyzed clinical experiences of 19 patients for recent 6 years who were undergone the reconstructive flap surgeries for mid-facial defects using forehead, dorsal nasal and retroangular flaps based on anastomosed vascular network in inner canthal region. As a result of review, the authors could not get an exact conclusion, although there were numerous opinions about anatomical variations of facial and angular artery. However, robust network composed of anastomotic arteries in inner canthal region seems to give high viability to flaps due to rich blood supply regardless of variation. Clinical experiences also showed excellent flap viability without any complication and satisfactory results functionally and cosmetically. In conclusion, flaps using vascular network in inner canthal region should be suggested as safe and effective methods for mid-facial reconstruction.