An Algorithm to Guide Recipient Vessel Selection in Cases of Free Functional Muscle Transfer for Facial Reanimation

Abstract

BackgroundThe aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent.MethodsPatients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon.ResultsEighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05).ConclusionsOur algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes

“…Though optimal recipient vessel selection is crucial for any free-flap reconstruction, [18][19][20][21][22][23][24] this topic has been neglected in most phalloplasty reports, 25 which only describe the FA and GSV as recipient vessels. 8,10,11,15,[26][27][28][29][30][31] In one of the only available studies discussing alternative recipient vessel choices, 25,39 Danker et al 25 discuss the DIEV's reliability as an adjunct to the GSV for venous outflow, with improvement of outcomes after adding the DIEV.…”

“…Proper recipient vessel selection is crucial for all free flaps, [18][19][20][21][22][23][24] but literature explaining phalloplasty recipient vessel selection is extremely limited. 25 Most phalloplasty descriptions 8,10,11,15,[26][27][28][29][30][31] highlight the femoral artery (FA) and great saphenous vein (GSV) as recipi-When alternatives to the FA, including the deep inferior epigastric artery and its venae comitantes (DIEA/V), are mentioned, only cursory attention is paid to technique and selection rationale.…”

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

“…Although most candidates for facial motion restoration have recipient vessels in the proximity of the paralyzed side of the face, 4,32,33 it is important to state that in radical resection for ablative surgery, and/ or intra-arterial chemotherapy, suitable vessels for microvascular anastomosis might not be available. 34 Some authors 4 recommend abandoning the procedure if no recipient vessels are found in the ipsilateral face or neck. However, we believe that contralateral vessels could be useful to provide blood flow, requiring interposition grafts.…”

Use of the submental vessels for free gracilis muscle transfer for smile reanimation

“…Although not well reported, use of the submental vessel is not new. In a review by Henry et al, among 98 hemifaces that underwent free muscle transfer (not limited to gracilis), 88 used the facial artery for anastomosis and 1 used the “submandibular branch of the facial artery.” Additionally, the review noted that 33% of patients with prior facial surgery or trauma lacked a suitable facial artery.…”