Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Abstract

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.

Transverse Cervical Artery for Head and Neck Reconstruction with Free Jejunal Flaps: A Retrospective Study of Computed Tomography Angiography

“…Selection and preparation strategies for recipient arteries and veins have been reported by several authors. [1][2][3][4][5][6][7][8][9][10] Branches of the external carotid artery, including the superior thyroid artery (STA), are commonly used as recipient arteries for microvascular head and neck reconstruction. 1,11 The STA is preferred because it is often located near to the surgical defect and easy to identify and dissect; however, using the STA has several disadvantages.…”

“…Selection and preparation strategies for recipient arteries and veins have been reported by several authors. 1 2 3 4 5 6 7 8 9 10…”

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

“…Due to these treatments, the local soft tissue around the operating field is usually extensively scarred and retracted which might produce external compression on the pedicle and the anastomosis site. Tanaka et al 37 report higher rates of venous complications when using ST vessels for H&N reconstruction and secondary revision procedures compared with skull base reconstruction. The authors cite a wider surgical field, less prone to compression and the frequent usage of the middle temporal vein as the main differences between the reconstruction technique for each indications.…”

Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach

“…The proximity these vessels have to the scalp makes them favorable as recipient vessels and despite the above noted possible size mismatch, the efficacy of the superficial temporal vessels has been shown by other authors as well. [27][28][29][30][31] The facial artery and vein can also be selected as recipient vessels. The primary microvascular anastomoses can be done directly from the flap pedicle vessels to the facial vessels when a frontal scalp defect is reconstructed.…”