Superficial Temporal Versus Cervical Recipient Vessels in Maxillary and Midface Free Vascularized Tissue Reconstruction: Our 14-Year Experience

Li, Jun; Shen, Yi; Wang, Liang; Wang, Jinbing; Sun, Jian; Haugen, Thorsen W.

doi:10.1016/j.joms.2018.02.008

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…The superficial temporal system is a convenient target for upper and midfacial reconstruction given its proximity to the defect and ease of identification with a low complication rate and improved cosmesis compared to a cervical incision. 18 In 8% of cases in this series, the superficial temporal system was selected, and no flap failures were observed in this group. However, prior bicoronal incision, neck dissection, or parotidectomy could damage these vessels, and other times their small caliber may be inadequate to power a large free flap.…”

Section: Discussionmentioning

confidence: 79%

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

et al. 2021

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Objectives: Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if there was any association with flap survival or postoperative complications.Study Design: Retrospective review at three tertiary care institutions. Methods: Database review.Results: Free flap reconstruction of the upper and midface was performed in 295 patients (108 bony, 187 soft tissue). In 82% of cases, the vessels reached the ipsilateral neck for anastomosis to traditional target vessels. Arterial grafts were required in 2% of reconstructions (4% bony and 1% soft tissue). Venous grafting was required in 7% of reconstructions (21% fibula, 16% scapula, and 3% soft tissue) and was associated with an increase in flap failure rate (19% vs 3%, P = .003). The most common recipient artery for revascularization was the cervical facial artery (78%). Alternate recipient vessels were selected in 13% of cases, including the superficial temporal vessels (7%), distal facial branches through a separate facial incision (4%), and angular vessels (2%). Vein grafting was associated with a higher flap failure rate. Alternative maneuvers did not affect need for intraoperative pedicle revision or complications.Conclusions: In upper and midface reconstruction, vascular grafting, targeting more distal branches of the facial system, or additional maneuvers to optimize pedicle orientation is often required to secure revascularization. Vein grafting is associated with a higher free flap failure rate. Scapular border flaps often require vascular grafting or atypical anastomotic locations.

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Section: Discussionmentioning

confidence: 79%

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

et al. 2021

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“…Recent studies have reported that the postoperative complication rate of vascular anastomosis using the superficial temporal artery and STV is similar to that in patients with vascular anastomosis using cervical recipient vessels. [3][4][5][6][7][8] However, surgical indications and patient selection might have been biased, and postoperative outcomes might have been overestimated. Therefore, vascular anastomosis in the temporal region is generally not recommended as the first-line choice for common head and neck reconstructive microsurgeries.…”

Section: Discussionmentioning

confidence: 99%

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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“…Another is using venous and/or arterial grafting when the pedicle length is insufficient to reach the cervical vessels. However, grafting may be associated with higher failure rates [6,7] . Alternative recipient vessels can be used with demonstrated success.…”

Section: Principles Of Skull Base Reconstructionmentioning

confidence: 99%

Free tissue transfer for skull base reconstruction - a review

Swendseid¹,

Chaskes²,

Philips³

et al. 2021

PAR

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Evolutions in skull base surgery and reconstructive technique have given surgeons the confidence to resect and repair increasingly advanced skull base pathologies. Free tissue transfer (FTT) provides a versatile option capable of addressing numerous simultaneous reconstructive goals. This review highlights some of the nuances, challenges, and considerations of performing FTT for skull base reconstruction in the anterior, central and lateral skull base. This review combines the expert opinion of the senior authors with those of the field at large as queried through PubMed searches regarding skull base reconstruction and FTT. Reconstructive goals include separation of intracranial from extracranial cavities, obliteration of dead space, and protection of vascular and neural structures. Atypical vascular pedicle management is commonly needed, especially for endonasal and central skull base resection. Virtual surgical planning may be beneficial for complex bony reconstruction. Familiarity with common complications such as cerebrospinal fluid leak, nasocutaneous fistula, and inferior flap displacement, as well as associations for their development, can help plan the reconstruction to minimize morbidity.

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Superficial Temporal Versus Cervical Recipient Vessels in Maxillary and Midface Free Vascularized Tissue Reconstruction: Our 14-Year Experience

Cited by 14 publications

References 21 publications

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

Free tissue transfer for skull base reconstruction - a review

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