Nose and lips graft variants: a subunit anatomical study

Background. In the field of Vascularized Composite tissue Allotransplantation (VCA), the surgical design of facial subunit grafts is an evolving concept. The purpose of the present paper is to study the possibilities to divide the historical nose and lips face transplant into several morphological and functional subunit grafts, depending on their respective supply. Methods. Our study was conducted in 20 adult cadavers. The facial artery and its branches were dissected bilaterally in 16 fresh and 4 embalmed heads. Nasolabial perfusion was assessed by selective injection of methylene blue and eosin (n=2) or indian ink (n=2) in superior labial artery (SLA) and distal facial artery (DFA). Dynamic perfusion through the DFA was illustrated by fluoroscopy (n=3). Three nose-upper lip grafts were harvested and injected with barium sulfate for micro-Angio CT analysis. Finally, three isolated nasal and bilabial grafts were procured and their vascular patency assessed by fluoroscopy. Results. DFA can perfuse the entire nose, septum and upper lip, without any contribution of SLA. A dense anastomotic network indeed exists between the respective distal rami of both vessels. Furthermore, the exclusion of SLA from the harvested nasal subunit allowed safe bilabial subunit procurement, from the same specimen. Conclusions. Our results demonstrate the feasibility of harvesting nasal and labial subunits, in an isolated or a combined manner. These results can find applications in subunit autologous replantation, allotransplantation, allogenic face partial retransplantation, and in the emerging field of vascularized composite tissue engineering. Financial Disclosure Statement: The authors have no conflict of interest to disclose. This work was financially supported by a Fondation Saint-Luc Grant, FSR-UCL (Fonds Spécial de la Recherche) and Fonds Dr. Gaëtan Lagneaux. The content of the work is solely the responsibility of the authors. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Acknowledgments: We would like to thank Mrs. Pascale Segers and Mr Walter Hudders for manuscript editing, Mrs. Michelle Cougnon and Mr Eric Legrand for administrative support, Mr. Bernard Caelen and Mrs. Maïté Van de Woestijne for assistance in cadaver procurement, Prof. Anne Bol for Micro-CT acquisition support. Conflict of interest: none. Authorships: JD Designed study, performed part of experimental manipulations, reviewed and interpreted all data, wrote article, gave approval for publication. LM Performed part of experimental manipulations, participated to data collection and analysis, gave approval for publication AG Performed part of experimental manipulations, participated to data collection and analysis, revised article, gave approval for publication MV Performed radiographic acquisition and reconstruction, reviewed and interpreted data, gave approval for publication. PG Supported experiments, reviewed and interpreted data, revised article, gave approval for publication. CB Supported experiments, reviewed and interpreted data, revised article, gave approval for publication. BL Supported experiments and designed study, reviewed data, revised article extensively, gave final approval for publication. Corresponding author: Benoît Lengelé, MD, PhD, FRCS, UCL/IREC/MORF,, Avenue E. Mounier 51, Bte B1.52.04, B-1200 Brussels (BELGIUM) Tel: +3227645251, Fax: + 3227645225, E-mail : benoit.lengele@uclouvain.be ©2017American Society of Plastic Surgeons

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