The course and variation of the facial artery and vein: implications for facial transplantation and facial surgery.

The main arterial supply of the facial skin envelope is the facial artery which serves as the main pedicle for a number of facial flaps, including a facial transplant graft. This study explored the course of the facial artery and vein, branching patterns, terminations, and anomalous variants. Cadaveric dissections of 201 facial arteries and 198 facial veins were performed. All branches originated from a single facial arterial trunk in 86% of specimens and branching patterns were symmetrical in 53%. The facial artery predominantly terminated as a lateral nasal artery (49%). In 5 cases, the facial artery was undetectable with transverse facial arterial dominance (1 case bilateral). The facial vein was predictable in position except for 2 instances, being replaced by a transverse facial vein (unilateral). Facial arterial dominance in facial blood supply is common but unpredictable. Careful vascular workup prior to facial transplantation and unipedicled flap procedures is therefore essential.