Anatomical considerations in using Facial Artery Musculo-Mucosal (FAMM) flap as a pedicled/tunnelised flap - a cadaveric study.

Abstract

Objectives: To investigate the anatomical basis of the pedicled/tunnelised Facial Artery Musculomucosal (FAMM) flap and to assess potential sex-based differences in the relevant anatomical parameters. This study aims to assist in surgical planning and assess the suitability of the FAMM flap as a pedicled/tunnelised option for orofacial reconstruction. Methods: The present study consisted of 4 fresh frozen heads (8 FAMM flaps), including 2 males and 2 females, obtained from Anatomy, University of Edinburgh, under the regulation of the Human Tissue (Scotland) Act 2006. Gelatin and methylene blue solution were used to perfuse the facial artery (FA). The assessment of distances and lengths was conducted using a digital calliper. Chi-square, independent t-test, and Mann–Whitney's U tests were used to compare between sexes, and the P value was fixed at ≤ 0.05. Results: The most common FA variation type was type III (37.5%), with no significant difference between sexes. The maximum distance between the FA and the facial vein (FV) at the inferior margin of the mandible was 11.6 mm, and 30.3 mm at the mouth commissure. The mean number of perforating branches to the submandibular gland was 4 ± 1. The mean length of the FAMM flap was 176.1 ± 23.834 mm from the origin of the FA and 120.4 ± 14.976 mm from the inferior margin of the mandible, with a significant sex dimorphism. Conclusion: Based on the findings, the average length of the pedicled/tunnelised FAMM flap was 176.1 ± 23.834 mm from the origin of FA, indicating that it is a viable option for reconstruction in multiple regions. Understanding of the variant types of FA, the length of pedicled/ tunnelised FAMM flap, and their differences between sexes is essential for proper surgical planning before the use of the pedicled/tunnelised FAMM flap.