PDF herunterladen
J Reconstr Microsurg 2022; 38(08): 654-663
DOI: 10.1055/s-0042-1743165
Original Article

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Luís Mata Ribeiro   *
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taoyuan, Taiwan
2   Department of Plastic and Reconstructive Surgery, São José Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
,
Chung-Kan Tsao    *
3   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
4   Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Yu-Liang Hung
5   Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Chun-Hui Chu
5   Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Li-Ching Lin
5   Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Mo-Han Lin
6   Center of Tissue Engineering, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Chi Peng
3   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
,
David Chon-Fok Cheong
3   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
,
Shao-Yu Hung
3   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
,
Chun-Ta Liao
7   Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

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.

Keywords

fibula flap - microsurgery - superficial temporal

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.




Publikationsverlauf

Eingereicht: 22. September 2021

Angenommen: 27. Dezember 2021

Artikel online veröffentlicht:
25. Februar 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery 2007; 27 (07) 588-594
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009; 29 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Goertz O, von der Lohe L, Martinez-Olivera R. et al. Microsurgical reconstruction of extensive oncological scalp defects. Front Surg 2015; 2: 44
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Hussussian CJ, Reece GP. Microsurgical scalp reconstruction in the patient with cancer. Plast Reconstr Surg 2002; 109 (06) 1828-1834
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 45 Sullivan SK, Dellacroce F, Allen R. Management of significant venous discrepancy with microvascular venous coupler. J Reconstr Microsurg 2003; 19 (06) 377-380
    Artikel in Thieme ConnectPubMedGoogle Scholar