The use of color Doppler ultrasound in the assessment of vessels for facial transplantation.

The facial artery has been proposed as the main vascular pedicle in facial transplantation. An anatomic study of 200 consecutive facial and transverse facial vessels in 100 normal individuals was performed using color Doppler ultrasound. The diameter and course of each facial vessel were measured at 3 fixed landmarks, and the branching pattern was documented up to the level of the nasal ala. The concomitant transverse artery and vein were similarly documented. The main branch of the facial artery was detected at the lower mandibular border in 99.5% (n = 199) of cases. The accompanying facial vein was found in 97.5% (n = 195) of cases, lateral to the artery in all cases. The transverse facial artery was present in 75.5% (n = 151) of cases, with the vein found in 58% (n = 116). When the facial artery was undetectable, there was transverse facial artery dominance. When the facial vein was absent, it was replaced with a transverse facial vein; this venous anomaly was accompanied by normal arterial supply pattern. This study is the first to describe the measurement of transverse facial vessels sonographically and confirms previous cadaveric studies of facial arterial and venous variation. Color Doppler can be used in the preoperative vascular assessment of both donor and recipient in facial transplantation.