Usability of the Middle Temporal Vein as a Recipient Vessel for Free Tissue Transfer in Skull-Base Reconstruction

Yano, Tomoyuki; Tanaka, Kentarou; Iida, Hideo; Kishimoto, Seiji; Okazaki, Mutsumi

doi:10.1097/sap.0b013e3182198c55

Cited by 15 publications

(14 citation statements)

References 15 publications

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“…Anatomic studies done on cadavers have identified an average STA diameter of 1.8 to 2.7 mm before its bifurcation into the frontal and parietal branches. [9][10][11][12][13] Comparable sizes for FA diameter have been reported with values ranging from 2.3 to 2.6 mm at the lower edge of the mandible. 14,15 Whereas smaller than diameters measured in cadavers, our results demonstrate that the two vessels are largely similar within the same patient indicating that vessel size is not a limitation of the STA/V.…”

Section: Discussionmentioning

confidence: 97%

“…Similar to the STA, the STV has often been considered a secondary or tertiary choice for venous outflow due largely to concerns over caliber and quality. 11,16 However, recent reports document average STV diameters between 2.1 and 3 mm. 17,18 In our series, the median STV diameter was approximately 2 mm, a size that is both usable and reliable.…”

Section: Discussionmentioning

confidence: 99%

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Superficial Temporal Artery and Vein as Recipient Vessels for Scalp and Facial Reconstruction: Radiographic Support for Underused Vessels

Doscher

Charafeddine

Schiff

et al. 2015

J reconstr Microsurg

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Superficial Temporal Artery and Vein as Recipient Vessels for Scalp and Facial Reconstruction: Radiographic Support for Underused Vessels

Doscher

Charafeddine

Schiff

et al. 2015

J reconstr Microsurg

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“…However, the difference between the two means is about half a millimeter (0.57 mm) and would not be considered clinically meaningful The DTV has previously been reported to always course through the superficial temporal fat pad, which has been considered a reliable anatomical landmark for identifying the vessel (Henry et al, 2012;Jung et al, 2014;Tansatit et al, 2015;Yano et al, 2012;Yano et al, 2014). The type VII sub-variant identified in our study instead courses posteriorly to the superficial temporal fat pad.…”

Section: Discussionmentioning

confidence: 99%

Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross‐sectional review of patient imaging

et al. 2022

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Purpose The deep temporal vein (DTV) can be used in free flap procedures when the superficial temporal vein is inadequate. Despite its potential utility, its branching patterns have only been examined in one small anatomic study. The purpose of this study was to examine computed tomography angiography (CTA) images to determine DTV location, variation, and suitability as a microvascular recipient, to provide surgeons with a guide for its use in head and neck defects. Methods A retrospective chart review identified 152 patient CTA images (76 female; 76 male) in a single academic center imaging database, selected consecutively from January 2017 to April 2020. Patients under 19 years were excluded; ages ranged from 19 to 80 years (average 51.6 years). Reason for imaging, DTV caliber, laterality, distance to zygomatic arch (ZA [coronal and sagittal]), distance to lateral orbital rim (LOR), and branching pattern were recorded. Results The predominant reason for imaging was to rule out cerebrovascular accident (96.2%). Average caliber was 3.46 ± 1.29 mm (95% confidence interval [CI] [3.32, 3.61]; range, 1.00–10.8). Bilateral DTVs were observed in 98.7% of patients. Average distance to landmarks were as follows: ZA (coronal), 13.8 ± 5.85 mm (95% CI [13.2, 14.5]; range, 2.7–33.8); ZA (sagittal), 15.1 ± 6.12 mm (95% CI [14.1, 16.1]; range, 2.8–47.2); LOR, 47.1 ± 9.09 mm (95% CI [46.0, 48.1]; range, 10.8–62.9). Seven branching patterns were identified, including a posterior vertical variant that bypasses the superficial temporal fat pad. Conclusions The DTV is a “lifeboat” option for head and neck reconstruction. Its average caliber is sufficient for use in microsurgery. Knowledge of both its typical and aberrant courses allow for efficient preoperative planning and surgical dissection. CTA is a useful adjunct when planning to use the DTV for free tissue transfer.

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“…In addition, MTV has been frequently selected as the recipient vein to improve the success rate of temporal vascular anastomosis in our institution, and its effectiveness has been demonstrated. 9,10 The MTV courses below the superficial layer of the deep temporal fascia and is distributed in the superficial temporal fat pad between the superficial and deep layers of the deep temporal fascia. 11 The MTV runs approximately parallel in a line between the lateral edge of the zygomatic arch and the eyebrow and joins the main trunk of the STV at the level of the zygomatic arch.…”

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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Usability of the Middle Temporal Vein as a Recipient Vessel for Free Tissue Transfer in Skull-Base Reconstruction

Cited by 15 publications

References 15 publications

Superficial Temporal Artery and Vein as Recipient Vessels for Scalp and Facial Reconstruction: Radiographic Support for Underused Vessels

Superficial Temporal Artery and Vein as Recipient Vessels for Scalp and Facial Reconstruction: Radiographic Support for Underused Vessels

Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross‐sectional review of patient imaging

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

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