Utilization of Intraparotid Segments of Superficial Temporal Vessels for Head and Scalp Free Flap Microanastomosis: A Clinical, Histological, and Cadaveric Study

Abstract

Background The superficial temporal vessels (STV) are an underutilized target for head and neck microvascular reconstruction. Most surgeons regard the dissection as difficult, unreliable, and the anastomosis prone to vasospasm. The intraparotid course of the STV may provide more reliable flow without accompanying morbidity. Methods A retrospective review of patients who underwent head and scalp free flap reconstruction utilizing STV intraparotid segment was performed. Demographic factors such as intraoperative and postoperative complications are reported. Five bilateral cadaver heads were dissected to describe the relationship to the facial nerve. STV histology was performed on four of the cadavers, noting intraluminal diameter and vessel wall thickness. Results Thirty-nine patients underwent free flap reconstruction with anastomosis to intraparotid STVs. Defect etiology included tumor resection (71.8%), traumatic brain injury (10.3%), intracranial bleed (12.8%), and acute trauma (5.1%). Flaps transferred included anterolateral thigh (51.3%), latissimus (33.3%), thoracodorsal artery perforator (7.7%), radial forearm (2.8%), and vastus lateralis (5.1%). Two flaps (5.1%) required takeback for arterial thrombosis, with one incidence of total flap loss (2.8%). There were no instances of transient or permanent facial nerve damage nor sialocele. On cadaver dissection, three distinct vessel segments were identified. Segments 1 and 2 represented the STVs superior to the upper tragal border. Segment 3 (intraparotid segment) began at the upper tragal border and STVs enlarged with a targeted anastomosis point at an average of 16.3 mm medial and 4.5 mm inferior to the upper border of the tragus. The frontal branch coursed 11.7 mm inferior and 11.5 mm anterior to this point. On histology, the intraluminal diameter of segment 3 was significantly larger than segment 2 (1.2 vs. 0.9 mm, p = 0.007). Conclusion Head and neck free flap reconstruction with microanastomosis to the intraparotid segment of STVs can be safely and reliably performed.

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes

“…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. The diameter of the MTV is significantly greater than that of the STV and is adequate for vascular anastomosis.…”

“…One of the measures is using intraparotid segments of superficial temporal vessels. 11 We usually use the temporal artery and vein in segments 1 and 2 superior to the upper tragal border in consideration of nutrient vessels length, and it has been described that arterial spasm occurs more frequently and the venous intraluminal diameter is smaller in these segments. 11 Arterial spasm was resolved during the long lag from the identification of recipient artery to the microvascular anastomosis.…”

“…11 We usually use the temporal artery and vein in segments 1 and 2 superior to the upper tragal border in consideration of nutrient vessels length, and it has been described that arterial spasm occurs more frequently and the venous intraluminal diameter is smaller in these segments. 11 Arterial spasm was resolved during the long lag from the identification of recipient artery to the microvascular anastomosis. The recipient artery was identified and exposed at the beginning of reconstructive surgery as early as possible, at the time of coronal incision in skull base surgery, and there was a long period until the timing of microvascular anastomosis.…”

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.…”

Superficial Temporal Vessels for Head and Scalp Microsurgical Reconstruction

“…We have read with interest the article entitled "Utilization of Intraparotid Segments of Superficial Temporal Vessels (STV) for Head and Scalp Free Flap Micronastomosis: A Clinical, Histological, and Cadaveric Study." 1 We congratulate Venkatesh et al for their relevant work. Superficial temporal vessels (STV) are very suitable vessels for head and scalp reconstruction 2 due to their proximity and relative easy dissection.…”