Mucosal perforators and mucosal perforasomes from the facial artery. Posible clinical uses and refinements in the harvesting perfofator flap techniques

Abstract

BACKGROUND: Neither the oral mucosal perforators of the facial artery, nor their mucosal perforasomes they perfused, have been described. Septal perforation is a frequent complication of snorting cocaine. Its reconstruction usually requires complex procedures based on oral mucosa o distant flaps. METHODS: We studied 30 facial arteries. First ten were injected with latex, diameter and length were measured. All perforators extending from the facial artery and heading directly to the oral mucosa were selected. The remaining twenty arteries were dissected. Perforators larger than 0.5 mm were selected and their diameters were measured; the distance between their exit point over the facial artery and the branching-off point from the superior labial artery was also measured. The selected perforators were injected with 1 cc of diluted ink. Both labial arteries were ligated to limit the study to the mucosal perforators from the facial artery. The results were analyzed statistically. Systematic reviews of PubMed and the Cochrane Library were performed in search of articles describing mucosal perforators or mucosal perforasomes. We describe a reconstruction of a septal defect caused by cocaine abuse in five patients using a flap based on mucosal perforasomes (MBPF) from the facial artery. RESULTS: From the specimens with latex, 52 oral mucosal perforators were analyzed. Mean diameter was 0.50 mm and mean number per facial artery was 5.2. Mean length was 16.42 mm. Seventy-four perforators from 20 hemifaces were ink injected; mean diameter was 0.58 mm, and mean number per artery was 3.7. Mean area perfused by each perforator was 274.71 sq. mm. Six types of mucosal perforasomes dependent on facial artery perforators were identified. MBPF obtains satisfactory results in reconstruction once the patient abandons the cocaine habit. CONCLUSIONS: Most of the mucosal perforators of the facial artery are found between the branching-off points of the inferior and superior labial arteries. To our knowledge, the concepts of mucosal perforators and mucosal perforasomes have not been described to date. Flaps based on mucosal perforasomes from the facial artery are useful for the reconstruction of septal perforation due to cocaine abuse and may open up promising new areas of research.