Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

Choi, Jong Woo; Kim, Young Chul; Jeon, Dong Neok; Jeong, Woo Shik; Koh, Kyoung Hwan; Oh, Tae Suk; Eom, Jin Sup; Kim, Eun Key; Hong, Joon Pio; Suh, Hyunsuk Peter

doi:10.1055/s-0039-1695054

Cited by 13 publications

(11 citation statements)

References 30 publications

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“…A previous report described the venous patency after head and neck reconstructions and concluded that a history of radiation treatments was the only factor associated with a higher risk of venous compromise. 12 At our institution, temporal vessels rarely had heavy radiation-induced damage, since the temporal region was not irradiated in most cases of head and neck cancer or skull base neoplasms. However, the site of microvascular anastomosis should be changed when the temporal region is heavily irradiated or damaged.…”

Section: Discussionmentioning

confidence: 97%

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Tanaka

Suesada

Homma

et al. 2021

J Reconstr Microsurg

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Background Although there are several potential recipient vessels in the neck, those in the temporal region are limited. In skull base reconstruction, there are difficulties associated with the anastomosing recipient vessels in the neck region since long nutrient vessels are needed in the flap. We evaluated the reliability of temporal vascular anastomosis by comparing surgical outcomes between reconstructive methods and examined which surgical procedures may achieve better results. Methods We examined the medical records of free tissue transfer cases between April 2007 and March 2018. Seventy-three surgeries were performed in the temporal region, including skull base reconstruction in 48, head and neck reconstruction (without skull base) in 16, and secondary surgery for head deformities in nine cases. In total, 445 neck surgeries were performed. Postoperative complications were retrospectively analyzed. Results The postoperative complication rates were 8.2 and 2.7% for all temporal and neck surgeries, respectively. There were no arterial complications in the temporal region and all of the six postoperative anastomotic complications were due to venous thrombosis. In contrast, there were 12 cases of vascular anastomotic complications, with six cases each of arterial and venous thrombosis in the neck. In the temporal region, the complication rate was 2.1% for skull base reconstruction, 11% for secondary revision, and 25% in head and neck reconstruction. The corresponding values for middle temporal vein (MTV) usage rates were 54, 22, and 25%. In skull base reconstruction, a coronal incision was made in all cases. A more frequent use of the MTV was associated with a reduced complication rate. Conclusion The low complication rate in the temporal region was attributed to the wide surgical field and low tension of anastomotic vessels. Multiple venous anastomoses, including those of the MTV, are recommended to prevent complications.

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Section: Discussionmentioning

confidence: 97%

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Tanaka

Suesada

Homma

et al. 2021

J Reconstr Microsurg

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“…However, some authors select the same side TCA, avoiding a graft by choosing a flap provided with a long pedicle (16). Some authors from their experience found that presurgical radiation therapy could impact flap survival (17). We avoided this inconvenience, preferring either main and long pedicle flaps or a perforator flap with an eccentric skin paddle or FFs with a more distal (caudal) bony component to gain pedicle length.…”

Section: Discussionmentioning

confidence: 99%

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

Iacoviello

Bacigaluppi²,

Callegari³

et al. 2022

Front. Surg.

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BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.

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“…Their involvement in paediatric living donor hepatic transplantation has been shown to decrease hepatic artery thrombosis rates to under 5%, 20 and modern day series of free flap reconstruction have success rates over 98%. 21 …”

Section: Discussionmentioning

confidence: 99%

Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review

Iyer

Joharifard

Le‐Nguyen

et al. 2021

EJVES Vascular Forum

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Introduction Congenital aneurysms of major arteries are very rare diagnoses and prognosis can be poor if treatment is not initiated rapidly. This is the presentation of two cases of infants with congenital iliac aneurysms who underwent treatment in the neonatal period. The report then proceeds with a literature review of paediatric iliac aneurysms. Report Case 1: A female neonate was diagnosed antenatally with right common iliac (CIA) and internal iliac (IIA) artery aneurysms. Embolisation on day of life (DOL) eight was impossible because of partial thrombosis. The infant was subsequently observed for several months and the aneurysm was injected percutaneously with thrombin on DOL 78. A small residual aneurysm was coil embolised at five months of age. Satisfactory results were observed at one year follow up. Case 2: A female neonate was diagnosed antenatally on routine third trimester ultrasound with voluminous, bilateral CIA aneurysms. The patient underwent surgery on DOL 9 for aneurysm resection and microsurgical vascular reconstruction. The intervention was successful with triphasic flow through the anastomoses on colour Doppler ultrasound at six week follow up. Discussion Ten cases of congenital iliac aneurysms have been reported previously, with just two diagnosed in the neonatal period and eight undergoing surgical intervention. Definitive management to avoid aneurysm rupture or thrombosis should be timed carefully, and sometimes delayed with watchful waiting, to maximise success and minimise complications. Surgery is the key treatment modality, but endovascular intervention can be considered in selected cases. Congenital iliac aneurysms should be addressed at the safest time for the patient. Following resection, primary microvascular anastomosis is the ideal reconstructive technique, but other options for neonates have been described. Endovascular treatment should be considered for anatomically amenable saccular aneurysms.

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Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

Cited by 13 publications

References 30 publications

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review

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