Geometry of the Vascular Pedicle in Free Tissue Transfers to the Head and Neck

Urken, Mark L.; Vickery, Carlin; Weinberg, Hubert; Buchbinder, Daniel; Biller, Hugh F.

doi:10.1001/archotol.1989.01860320064020

Cited by 84 publications

(55 citation statements)

References 10 publications

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“…These flaps provide consistent, vascular pedicles with adequate length and diameter. 3,4,6,7,19 As soft-tissue defects are usually superficial, the direction and pedicle of these flaps can more easily be changed during inset so as to reach the vessels more easily (see Fig. 4).…”

Section: Recipient Vessels For Soft Tissue Flapmentioning

confidence: 99%

“…3,8,20,[30][31][32] However, the external jugular vein is preferred as the recipient vein in other reports. 6,33 There are some controversies about the selection of recipient veins after neck dissection. In radical or modified radical neck dissections in which the internal jugular vein is sacrificed, the external jugular vein may be the only readily available recipient vessel on the dissected side.…”

Section: Recipient Veinsmentioning

confidence: 99%

“…The recipient veins should be prepared close to the recipient artery to prevent excessive separation on pedicle vessels and to prevent kinking or pulling the artery and vein in different directions with changes in head position. 3,6 …”

Section: Recipient Veinsmentioning

confidence: 99%

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Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

Yazar

2007

Microsurgery

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The development of microsurgical techniques has facilitated proper management of extensive head and neck defects and deformities. Bone or soft tissue can be selected to permit reconstruction with functional and aesthetic results. However, for free tissue transfer to be successful, proper selection of recipient vessels is as essential as the many other factors that affect the final result. In this article selection strategies for recipient vessels for osteocutaneous free flaps, soft tissue free flaps, previously dissected and irradiated areas, recurrent and subsequent secondary reconstructions, simultaneous double free flap transfers in reconstruction of extensive composite head and neck defects, and the selection of recipient veins are reviewed in order to provide an algorithm for the selection of recipient vessels for head and neck reconstruction.

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Section: Recipient Vessels For Soft Tissue Flapmentioning

confidence: 99%

Section: Recipient Veinsmentioning

confidence: 99%

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Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

Yazar

2007

Microsurgery

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“…14,15 The artery which is flipped up for anastomosis sometimes kinks at its root because the natural lie of the artery is caudal.…”

Section: Discussionmentioning

confidence: 99%

Versatility of a posterior‐wall‐first anastomotic technique using a short‐thread double‐needle microsuture for atherosclerotic arterial anastomosis

et al. 2008

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To perform safe anastomosis for atherosclerotic arteries, we employed a posterior-wall-first anastomotic technique with a short-thread double-needle microsuture. Between October 2005 and September 2007, we performed 17 free flap transfers to the head and neck regions with this technique. Fifteen of 17 patients had one or more risk factors for atherosclerosis. In all patients except one, the superior thyroid artery was employed as a recipient artery and end-to-end anastomosis was performed close to its origin with the external carotid artery. Postoperatively, no anastomotic thrombosis occurred in any patients. The greatest advantage of the double-needle microsuture is that each stitch can be placed from the inner side of the arterial wall to the outer side. This "inner-to-outer" stitch secures full-thickness bite and minimizes intimal damage. Safe and reliable anastomosis could be carried out in an unfavorable setting because the double-needle suture offers a high degree of freedom in suture placement.

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“…This situation can occur rapidly at the site of anastomosis or its development may be delayed resulting in secondary ischemia. Patient selection, vessel selection, and attention to vessel geometry are not totally sufficient to avoid flap failure [13]. There must be a very meticulous microvascular technique to minimize damage to the vascular endothelium [9].…”

Section: Introductionmentioning

confidence: 99%

Early microscopic evidence for endothelial damage in arterial microanastomoses

et al. 2003

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Thrombosis of the arterial microanastomosis is the major reason for flap complications. Thrombus formation can occur rapidly at the site of anastomosis, or it may be delayed in developing, inducing secondary ischemia. The damaged endothelial cells and the exposed connective tissue play an important role in the molecular and cell mechanisms of coagulation and thrombosis. For this reason the early morphological changes in the endothelial cell layer after arterial microanastomoses in the rat were investigated. The results showed that the anastomotic site appeared completely sealed, with cut ends protruding into the vessel lumen. Extensive deendothelialized areas with fibrin deposition were visible between surgical microclamps on the inner surface of the artery. For this reason we believe that the damaged endothelium and exposed connective tissue elements are the primary cause of thrombin formation, platelet accumulation, and thrombosis at the anastomotic site. The reconstructive surgeon must employ a very meticulous microvascular technique to minimize damage to the vascular endothelium.

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Geometry of the Vascular Pedicle in Free Tissue Transfers to the Head and Neck

Cited by 84 publications

References 10 publications

Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

Versatility of a posterior‐wall‐first anastomotic technique using a short‐thread double‐needle microsuture for atherosclerotic arterial anastomosis

Early microscopic evidence for endothelial damage in arterial microanastomoses

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