Angular Vessels for Free‐Tissue Transfer in Head and Neck Reconstruction: Clinical Outcomes

Abstract

Objectives/Hypothesis: To evaluate the efficacy and reconstructive applications of angular vessel microvascular anastomosis in free-tissue transfer. Study Design: Retrospective cohort study. Methods: A study of patients treated from January 2010 to July 2017 was performed. Four hundred thirty patients undergoing free-tissue transfer at the Cleveland Clinic by a single reconstructive surgeon were reviewed. Patients in whom free-tissue transfer was performed using angular vessels were included. Patients in whom free-tissue transfer was performed using another vascular supply of the head and neck were excluded. Primary outcome was free-flap failure. Secondary outcomes included other postoperative complications and hospital length of stay. Results: Thirty-one patients underwent free-tissue transfer with microvascular anastomosis to the angular vessels during the study period. Seventy-one percent of patients underwent reconstruction immediately following tumor ablation. A variety of primary subsites were reconstructed; 58% underwent nasal reconstruction, 16% orbit/skull base reconstruction, 13% palatal reconstruction, 6% maxillary reconstruction, and 6% mandible reconstruction. Eighty-seven percent of patients underwent free-tissue transfer from an anterolateral thigh donor site. Ninety-seven percent of patients had successful free-tissue transfer with a viable flap during the follow-up period; only one patient experienced flap failure attributed to vascular insufficiency. Average length of stay was 4.7 days, and the most common length of stay was 3 days. Conclusions: The angular vessels provide excellent arterial supply and venous drainage to serve as a viable option for microvascular anastomosis during free-tissue transfer for head and neck reconstructive surgery. They are an ideal vascular source for central face and skull base reconstruction.

Minimally Invasive Approach to Access Vessels for Microvascular Anastomosis in Head and Neck Reconstruction

“…An additional theoretical benefit provided by the minimal access incision relates to cosmesis, with a smaller and/or hidden incision providing patients with the potential for superior cosmetic outcomes. In our previous study examining the use of the angular vessel system for microvascular reconstruction, we demonstrated that the use of the nasolabial fold incision did not result in any facial asymmetry or permanent weakness 11 . However, further studies should be undertaken to more quantitatively assess the cosmetic outcomes of this approach.…”

“…In our previous study examining the use of the angular vessel system for microvascular reconstruction, we demonstrated that the use of the nasolabial fold incision did not result in any facial asymmetry or permanent weakness. 11 However, further studies should be undertaken to more quantitatively assess the cosmetic outcomes of this approach. Finally, by avoiding traditional neck exploration in favor of a minimal access approach, there is the potential for a quicker recovery and more expedited discharge from the hospital.…”

Anterior skull base reconstruction: a contemporary review

“…The dorsal scapular artery has also been described as a viable recipient vessel during free flap reconstruction in a vessel-depleted neck [64] . Interposition vein grafts may be required to lengthen the venous and/or arterial pedicle despite appropriate pre-operative planning and intra-operative efforts with overall success rates around 85% [65] . Different vein grafts have been described in the literature, such as the external jugular, facial, and cephalic, but the saphenous vein is most commonly used.…”

Free tissue transfer for skull base reconstruction - a review

“…For example, the superficial temporal vessels are often easily reachable and have high success rates when there is minimal size mismatch. Unfortunately, prior surgeries such as craniotomies may damage them, making them non-viable recipient vessels [8] . The angular vessels are another recipient vessel option that has a high success rate and does not require as long a pedicle as cervical vessels [9] .…”