Free tissue transfer (FTT) has transformed the capabilities in head and neck reconstruction. Rotational and pedicled flaps are limited by the pedicle length, the type of tissue required and the size of the defect. FTT helps lessen the impact of some of these issues although its main limitation is pedicle reach for the anastomosis to the inflow and outflow tract. The use of the terminal branch of the facial artery, the angular artery has been described extensively in facial plastic surgery literature. The angular vessels, owing to their high central location in the mid face and accessibility via a camouflaged nasolabial fold incision, may have value in midfacial and nasal reconstructions. This study used 13 cadaveric heads to derive 26 angular arteries and veins. It found that the angular vessels have a consistent anatomical location deep to the intersection point of the nasolabial fold and vertical line through the oral commissure. The vein consistently runs in a deeper plan than the artery 1.5cm superior to the artery along the lateral border of zygomaticus major / minor complex. The mean (SD) artery diameter was 2.34 (0.67)mm prior to dilation and 3.21 (0.87)mm after dilation. The diameters of the vein before and after dilation were 3.57 (0.53)mm and 6.40 (0.81)mm. This study shows that the angular vessels can be reliably dissected using known landmarks, that they have adequate calibre for microvascular anastomosis.
Use of angular vessels in head and neck free-tissue transfer – a comprehensive preclinical evaluation
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