The evolution of facial artery perforator flap for midface reconstruction with preoperative ultrasound examination

Background Medium and small size defects of the midface are still a surgical reconstructive challenge. Nasolabial flap is a good choice for these cases, but secondary surgeries are usually needed to adapt or debulk the flap. The authors propose preoperative ultrasound examination to design the flap based on a perforator of the facial artery. Methods Twenty-one patients who have undergone a midface reconstruction with a facial artery perforator flap were included. Clinical data, surgical outcomes, and complications were collected. Preoperative ultrasound examination was performed in all cases in order to identify a perforator of the facial artery and the final flap was design based on it. Results In all cases, a perforator of the facial artery was found using ultrasounds. In all cases, functional and esthetic outcomes were achieved and none of the patients asked for a secondary cosmetic procedure. Complications included partial skin loss of the flaps in two cases and temporary edema in three cases, with no need of a secondary procedure required. Conclusions The facial artery perforator flap based on a perforator of the facial artery is safe, versatile, and one-stage alternative to the traditional randomized nasolabial flap in the reconstruction of small-to-moderate–sized facial defects, with adequate functional and esthetic results and low morbidity of the donor site. Preoperative ultrasound examination improves the design of the flap and the selection of the best perforator and reduces the need to skeletonize the perforator; consequently, it reduces postoperative complications and the total surgical time. Level of evidence: Level IV, Risk/Prognostic.