目的 探讨以面动脉颈部细小穿支为蒂扩张皮瓣的临床应用和相关穿支血管的解剖。

方法 通过对4具新鲜尸体颈部区域的解剖，识别从面动脉直接发出到皮肤的细小穿支血管，记录穿支血管的走向位置和数量、直径；以解剖发现为基础，一期手术在颈阔肌和皮下组织间分离后，埋置扩张器时，保留面动脉颈部细小穿支及血管蒂穿出部部分肌袖，扩张2周后，二期设计以面动脉颈部细小穿支为蒂的颈部扩张皮瓣，通过旋转、推进或者经隧道形式，转移修复面部创面。

结果 解剖显示面动脉在下颌缘区域发出3-4支穿支血管，垂直穿过颈阔肌层，到达颈部浅筋膜层，供应颈部皮肤，从起点到皮肤的面动脉穿支长12-30mm（平均19mm），直径0.3-1.6mm（平均1.1mm）；临床应用中，所设计的19例以面动脉颈部细小穿支为蒂颈部扩张皮瓣均完全成活，转移皮瓣颜色、质地、外形和局部面部搭配，功能恢复满意，供区愈合良好，颈部活动不受限。

结论 扩张技术使面动脉颈部细小穿支能够在颈部形成更大面积的扩张皮瓣，对于大面积面部软组织缺损，面动脉颈部细小穿支扩张皮瓣是一种理想的修复方法。

Objective To explore the anatomy of expended facial artery perforator flaps with cervical small perforators and the clinical application for extensive facial defects with these flaps.

Methods Necks of fresh cadavers were dissected for studying the anatomy basis of expended facial artery perforator flaps with cervical small perforators. The small perforators derived from facial artery were recognized and number, diameter, route of these vessels were recorded. Based on the anatomy basis, two-stage operation was performed. In the first stage, expander was embedded above the platysma and the pedicle, cervical small facial artery perforator, was reserved. After two weeks, in the second stage, the expended perforator flap was transferred as propeller flap, advanced flap or tunnel flap to reconstruct extensive facial defects.

Results Cadavers dissection research revealed 3 or 4 perforators were out from facial artery when it crossed marginal mandibular and vertically penetrated platysma to the superficial fascia layer to supply cervical skin. The perforators from the origin at the facial artery to the skin, ranged from 12 to 30mm (average, 19mm). The diameters of the facial artery perforators at the level of origin of the facial artery ranged from 0.3 to 1.6mm (average, 1.1mm). In clinic, all flaps presented with satisfactory functional and aesthetic outcomes.

Conclusions This design of expended facial artery perforator flaps with cervical small perforators provide an excellent method for reconstruction of extensive facial defects.