Replantation of a large amputated segment of the face: a new technique

Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers

Background:

In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.

Methods:

The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.

Results:

The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.

Conclusion:

When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.

Exploring the Possibility of a Retrograde Embolism Pathway from the Facial Artery to the Ophthalmic Artery System In Vivo

BACKGROUND

Blindness caused by soft tissue fillers is an extremely low-probability event, but it results in great concern because of its devastating consequences. Currently, the mechanism of an embolism is usually considered to be an accidental injection of fillers into the blood vessels of the face, such as a facial artery, and then retrograding into the ophthalmic artery system, which causes retinal ischemic necrosis. In addition, previous studies have shown that there are anastomoses between facial arteries and branches of the ophthalmic artery in cadavers. An in vivo study, however, has not yet been reported.

METHODS

This study was approved by the institutional review board of Xijing Hospital, Fourth Military Medical University. Under general anesthesia, we dissected the same side of the face and eyeball in rabbits to manifest the facial artery and retina separately. Later, a needle (27 g) connected to a syringe (10 ml) full of methylene blue was inserted into a rabbit facial artery. Then, after poking a tiny hole in the central retinal artery, methylene blue was injected into the facial artery as quickly as possible (0.5 ml per second). At the same time, we carefully observed whether the central retinal artery had dye spillover or staining in the sclera. If blue dye was observed in the eye ground and/or the sclera, then it was thought to have entered the ophthalmic artery system (a positive result). In contrast, if none of the blue dye was observed, it was considered a negative result. A Chi-square (χ ²) test with a fourfold table was used to compare the differences in the frequencies of blue dye observed between living and dead rabbits. A value of p < 0.05 was considered significant.

RESULTS

One of the 20 rabbits showed the appearance of blue dye in the ophthalmic artery system in vivo, and the remaining 19 living rabbits had negative results. All 20 of the dead rabbits showed dye appearance in the eye ground. A statistically significant difference existed between the living and dead rabbits (p < 0.05).

CONCLUSION

In vivo, fillers can retrogradely enter the ophthalmic artery if the fillers entered the facial artery. Although the possibility is much lower in vivo than it is in corpses, adequate attention should be paid because of the catastrophic complications.

LEVEL OF EVIDENCE V

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