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

Abstract

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.

CT Angiography for Surgical Planning in Face Transplantation Candidates

“…Although the head and neck have a rich and often redundant vascular network, 21 in our experience, it is common that the typical target vessels are depleted from either massive defects or multiple surgeries (Figs 2B, -C and 4). When it is available for surgery, CTA mapping of the course, caliber, contour, and 3D relationship to metal from the injury or prior surgeries is the most important preoperative step.…”

“…Long (15)(16)(17)(18)(19)(20)(21)(22) hours) operation times 5,6 and massive (up to 35 units) blood loss 7 have been reported. The vascular anastomoses are the most critical part of the operation.…”

Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects

“…Patients with a high anesthetic risk due to poor health status have to be excluded from extensive reconstructive procedures. Secondly, peripheral arterial occlusive disease and the cervical vessel status play an important role (Yazar 2007;Chia et al 2011). Feasibility of vascularized bone reconstruction and the choice of soft tissue transplants depend on peripheral and local vessel conditions.…”

Arteriovenous fistulas for microvascular head and neck reconstruction

“…M ajor head and neck defects are often the result of ablative surgery for squamous cell carcinoma, and microvascular reconstruction with vascularized tissue has greatly improved the functional and quality of life outcomes of these patients (1). For free tissue transfer to be successful, proper vessel selection is essential (1).…”

“…For free tissue transfer to be successful, proper vessel selection is essential (1). Unfortunately, recurrent disease and second primary malignancies are a persistent problem, and often occur after adjuvant chemoradiation (2).…”