The Submandibular-Facial Artery Perforator Flap (S-FAPF): A Novel Tool for Lower Face Reconstruction.

Abstract

Facial skin reconstruction is challenging, requiring tissue quality, color match, and optimal aesthetic outcomes. Local flaps, such as submental flaps, offer advantages over free flaps but can be limited by bulk or complex perforator dissection. We described the Submandibular-Facial Artery Perforator Flap (S-FAPF), a novel upper neck flap, including its anatomical basis, surgical technique, and clinical application. A 61-year-old male with a 3 × 6 cm basal cell carcinoma of the cheek underwent radical excision. A S-FAPF, pedicled on two robust indirect facial perforators from the submental artery, was harvested and tunneled to cover the defect. Intraoperative fluoroscopy confirmed flap perfusion. An ancillary defatting procedure was performed to optimize aesthetics. Flap survival was 100%, with excellent color, texture, and contour match. Donor-site morbidity was minimal; 12-month follow-up demonstrated high patient satisfaction and inconspicuous scarring. S-FAPF is a reliable, versatile, and technically straightforward option for lower facial reconstruction, particularly in bearded regions.