Subscribe to RSS
DOI: 10.1055/s-0042-1743165
Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps
![](https://www.thieme-connect.de/media/jrm/202208/lookinside/thumbnails/10-1055-s-0042-1743165_210282-1.jpg)
Abstract
Background Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels.
Methods We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels.
Results A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates.
Conclusion Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.
Ethical Statement
The Chang Gung Medical Foundation Institutional Review Board approved this study (IRB: 202100767B0), waiving the need for consent from study participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Chang Gung Medical Foundation Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent form for patient photographs was obtained from all individuals and the authors will provide it if requested.
* Co-first authors—these authors worked together on the manuscript and contributed equally.
Publication History
Received: 22 September 2021
Accepted: 27 December 2021
Article published online:
25 February 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg 2011; 27 (01) 47-56
- 2 Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004; 52 (02) 148-155 , discussion 156–157
- 3 Chung JH, Kim KJ, Jung KY, Baek SK, Park SH, Yoon ES. Recipient vessel selection for head and neck reconstruction: a 30-year experience in a single institution. Arch Craniofac Surg 2020; 21 (05) 269-275
- 4 Garg RK, Poore SO, Wieland AM, Sanchez R, Baskaya MK, Hartig GK. Recipient vessel selection in the difficult neck: outcomes of external carotid artery transposition and end-to-end microvascular anastomosis. Microsurgery 2017; 37 (02) 96-100
- 5 Yazar S, Wei FC, Chen HC. et al. Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects. Plast Reconstr Surg 2005; 115 (06) 1553-1561
- 6 Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery 2007; 27 (07) 588-594
- 7 Head C, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Blackwell KE. Microvascular reconstruction after previous neck dissection. Arch Otolaryngol Head Neck Surg 2002; 128 (03) 328-331
- 8 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009; 29 (01) 1-7
- 9 Chen JT, Sanchez R, Garg R, Poore S, Siebert JW. Helpful hints for the superficial temporal artery and vein as recipient vessels. Plast Reconstr Surg 2017; 139 (03) 818e-820e
- 10 Li J, Shen Y, Wang L, Wang JB, Sun J, Haugen TW. Superficial temporal versus cervical recipient vessels in maxillary and midface free vascularized tissue reconstruction: our 14-year experience. J Oral Maxillofac Surg 2018; 76 (08) 1786-1793
- 11 Shimizu F, Lin MP, Ellabban M, Evans GR, Cheng MH. Superficial temporal vessels as a reserve recipient site for microvascular head and neck reconstruction in vessel-depleted neck. Ann Plast Surg 2009; 62 (02) 134-138
- 12 Sudirman SR, Shih HS, Chen JC, Feng KM, Jeng SF. Superficial temporal vessels, both anterograde and retrograde limbs, are viable recipient vessels for recurrent head and neck reconstruction in patients with frozen neck. Head Neck 2019; 41 (10) 3618-3623
- 13 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6 (01) 16-20
- 14 Muresan C, Dorafshar AH, Rodriguez ED. A reappraisal of the free groin flap in aesthetic craniofacial reconstruction. Ann Plast Surg 2012; 68 (02) 175-179
- 15 Goertz O, von der Lohe L, Martinez-Olivera R. et al. Microsurgical reconstruction of extensive oncological scalp defects. Front Surg 2015; 2: 44
- 16 Hansen SL, Foster RD, Dosanjh AS, Mathes SJ, Hoffman WY, Leon P. Superficial temporal artery and vein as recipient vessels for facial and scalp microsurgical reconstruction. Plast Reconstr Surg 2007; 120 (07) 1879-1884
- 17 Doscher M, Charafeddine AH, Schiff BA. et al. Superficial temporal artery and vein as recipient vessels for scalp and facial reconstruction: radiographic support for underused vessels. J Reconstr Microsurg 2015; 31 (04) 249-253
- 18 Halvorson EG, Cordeiro PG, Disa JJ, Wallin EF, Mehrara BJ. Superficial temporal recipient vessels in microvascular orbit and scalp reconstruction of oncologic defects. J Reconstr Microsurg 2009; 25 (06) 383-387
- 19 Venkatesh V, Fracol M, Turin S, Ellis M, Alghoul M. Utilization of intraparotid segments of superficial temporal vessels for head and scalp free flap microanastomosis: a clinical, histological, and cadaveric study. J Reconstr Microsurg 2020; 36 (04) 253-260
- 20 Hussussian CJ, Reece GP. Microsurgical scalp reconstruction in the patient with cancer. Plast Reconstr Surg 2002; 109 (06) 1828-1834
- 21 Bakhach J, Dibo S, Zgheib ER, Papazian N. The V-plasty: a novel microsurgical technique for anastomosis of vessels with marked size discrepancy. J Reconstr Microsurg 2016; 32 (02) 128-136
- 22 Bali ZU, Evrenos MK, Karatan B, Kececi Y, Yoleri L. An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip. J Plast Surg Hand Surg 2020; 54 (01) 19-23
- 23 Lee YC, Chen WC, Chen SH. et al. One versus two venous anastomoses in anterolateral thigh flap reconstruction after oral cancer ablation. Plast Reconstr Surg 2016; 138 (02) 481-489
- 24 Chen WF, Kung YP, Kang YC, Lawrence WT, Tsao CK. An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap. Microsurgery 2014; 34 (05) 377-383
- 25 Chang EI, Zhang H, Liu J, Yu P, Skoracki RJ, Hanasono MM. Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction. Head Neck 2016; 38 (Suppl. 01) E771-E775
- 26 Las DE, de Jong T, Zuidam JM, Verweij NM, Hovius SE, Mureau MA. Identification of independent risk factors for flap failure: a retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction. J Plast Reconstr Aesthet Surg 2016; 69 (07) 894-906
- 27 Mücke T, Rau A, Weitz J. et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2012; 48 (04) 367-371
- 28 Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007; 119 (07) 2092-2100
- 29 Wu CC, Lin PY, Chew KY, Kuo YR. Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery 2014; 34 (05) 339-344
- 30 Chang EI. Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: a 14-year review. Head Neck 2017; 39 (07) 1454-1458
- 31 Chiu YH, Chang DH, Perng CK. Vascular complications and free flap salvage in head and neck reconstructive surgery: analysis of 150 cases of reexploration. Ann Plast Surg 2017; 78 (3, suppl 2): S83-S88
- 32 Choi JW, Kim YC, Jeon DN. et al. Impact of recipient vein selection on venous patency and free flap survival in 652 head and neck reconstructions. J Reconstr Microsurg 2020; 36 (02) 73-81
- 33 Verhelst PJ, Dons F, Van Bever PJ, Schoenaers J, Nanhekhan L, Politis C. Fibula free flap in head and neck reconstruction: identifying risk factors for flap failure and analysis of postoperative complications in a low volume setting. Craniomaxillofac Trauma Reconstr 2019; 12 (03) 183-192
- 34 Han Z, Li J, Li H, Su M, Qin L. Single versus dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction: a retrospective study. Microsurgery 2013; 33 (08) 652-655
- 35 O'Brien CJ, Lee KK, Stern HS. et al. Evaluation of 250 free-flap reconstructions after resection of tumours of the head and neck. Aust N Z J Surg 1998; 68 (10) 698-701
- 36 Lee ZH, Alfonso AR, Stranix JT. et al. Vein size mismatch increases flap failure in lower extremity trauma free flap reconstruction. J Reconstr Microsurg 2019; 35 (08) 587-593
- 37 Tanaka K, Suesada N, Homma T, Mori H, Okazaki M. Reliability of temporal vascular anastomosis and techniques for better outcomes. J Reconstr Microsurg 2022; 38 (01) 41-46
- 38 Davison SP, Kaplan KA. The deep temporal vein: an alternative recipient vessel in microsurgical head and neck reconstruction. Plast Reconstr Surg 2005; 116 (04) 1181-1182
- 39 Henry SL, Weinfeld AB, Sharma SK, George TM, Kelley PK. The reliability and advantages of the sentinel vein as a microsurgical recipient vessel. J Reconstr Microsurg 2012; 28 (05) 301-304
- 40 Xu H, Jazayeri L, Matros E, Henderson PW. Anatomy, exposure, and preparation of recipient vessels in microsurgical head and neck reconstruction. J Reconstr Microsurg 2021; 37 (02) 97-110
- 41 Fossati E, Asurey N, Irigaray A. Application of Kunlin's technique in vascular micro-anastomosis: experimental and clinical study. Microsurgery 1985; 6 (01) 53-55
- 42 Xiu ZF, Song YG. A new technique to anastomose vessels with great discrepancy in diameter. Br J Plast Surg 1993; 46 (07) 619-620
- 43 Harashina T, Irigaray A. Expansion of smaller vessel diameter by fish-mouth incision in microvascular anastomosis with marked size discrepancy. Plast Reconstr Surg 1980; 65 (04) 502-503
- 44 Lauritzen C. A new and easier way to anastomose microvessels. An experimental study in rats. Scand J Plast Reconstr Surg 1978; 12 (03) 291-294
- 45 Sullivan SK, Dellacroce F, Allen R. Management of significant venous discrepancy with microvascular venous coupler. J Reconstr Microsurg 2003; 19 (06) 377-380