Regional Flaps and Their Blood Supply in Oral and Maxillofacial Surgery
Reconstructive surgery of the head and neck relies heavily on an understanding of regional flaps and their vascular supply. Regional flaps provide reliable, well-vascularized tissue for reconstruction following trauma, tumor resection, infection, or congenital defects. Their predictable blood flow makes them especially valuable in oral and maxillofacial surgery, where local anatomy is complex and tissue demands are high.
Successful flap design and survival depend on preserving the dominant arterial supply. Knowledge of flap vascular anatomy allows surgeons to minimize complications such as ischemia, necrosis, and wound breakdown while maximizing functional and esthetic outcomes.
What Are Regional Flaps?
Regional flaps are sections of tissue transferred from a nearby anatomical site while maintaining an intact blood supply. Unlike free flaps, regional flaps do not require microvascular anastomosis. They may include skin, muscle, fascia, mucosa, or combinations of these tissues, depending on reconstructive needs.
Regional flaps are commonly categorized as myocutaneous, fasciocutaneous, mucosal, or island flaps, and they may be designed as random-pattern flaps or axial flaps based on a known arterial pedicle.
Importance of Blood Supply in Flap Design
The viability of any regional flap is directly related to its arterial inflow and venous outflow. Axial flaps are based on a named artery and offer more predictable perfusion, while random flaps rely on subdermal plexuses and have more limited length-to-width ratios.
Understanding the dominant blood supply to each flap allows surgeons to plan incisions, rotation arcs, and inset positions safely, reducing the risk of partial or total flap loss.
Common Regional Flaps and Their Dominant Blood Supply
The pectoralis major myocutaneous flap is a workhorse flap in head and neck reconstruction. Its dominant blood supply arises from the thoracoacromial artery, with contributions from the superior and lateral thoracic arteries. This flap provides robust tissue bulk and reliable perfusion.
The deltopectoral skin flap is supplied by perforators from the internal mammary artery. It is useful for resurfacing defects of the neck and lower face.
The temporalis muscle flap, frequently used for maxillary, orbital, and cranial base reconstruction, receives its blood supply from the anterior and posterior deep temporal arteries.
The temporoparietal fascia flap is a thin, pliable flap supplied by the superficial temporal artery, making it ideal for auricular, orbital, and facial soft-tissue reconstruction.
The paramedian forehead flap is based on the supratrochlear artery and is commonly used in nasal reconstruction due to its excellent color and texture match.
The nasolabial flap may function as a random flap or as an axial flap when designed on the angular artery, offering versatility for intraoral and perioral defects.
The submental island flap derives its blood supply from the submental artery, a branch of the facial artery, and is frequently used for oral cavity and oropharyngeal reconstruction.
The facial arterial myomucosal (FAMM) flap is supplied by a branch of the facial artery, providing reliable mucosal tissue for intraoral reconstruction.
The tongue flap is most commonly designed as a random flap, though axial designs can be based on the dorsal lingual branch of the lingual artery, depending on defect location.
The palatal island flap receives its blood supply from the greater palatine artery, making it a dependable option for palatal and maxillary defects.
The platysma myocutaneous flap is supplied by the submental branch of the facial artery and can be used for lower facial and cervical reconstruction.
The trapezius myocutaneous flap is based on the transverse cervical artery, while the latissimus dorsi myocutaneous flap is supplied by the thoracodorsal artery, both offering large surface area coverage when needed.
The sternocleidomastoid myocutaneous flap receives vascular contributions from branches of the occipital and superior thyroid arteries, providing options for neck reconstruction.
The trapezius flap, distinct from the myocutaneous variant, is supplied by the dorsal scapular artery.
Finally, the supraclavicular flap, increasingly popular due to its thin profile and ease of harvest, is supplied by the supraclavicular artery and is commonly used for head and neck resurfacing.
Clinical Applications in Oral and Maxillofacial Surgery
Regional flaps are widely used to reconstruct defects following oral cancer resection, osteonecrosis treatment, trauma, and infection. Their reliable vascularity allows reconstruction in patients who may not be ideal candidates for free tissue transfer due to medical comorbidities or resource limitations.
Selecting the appropriate flap requires careful consideration of defect size, tissue requirements, arc of rotation, and vascular anatomy. Preoperative planning and precise surgical technique are essential for optimal outcomes.
Conclusion
Regional flaps remain a cornerstone of head and neck reconstruction. A thorough understanding of flap anatomy and dominant blood supply is critical for safe surgical planning and long-term success. When selected appropriately, regional flaps provide dependable, well-vascularized tissue with excellent functional and esthetic results.
