Cutaneous necrosis after superficial temporal artery-to-middle cerebral artery anastomosis: is it predictable or avoidable?
OBJECTIVE
This study was carried out to determine whether a relationship exists between cutaneous necrosis after superficial temporal artery-to-middle cerebral artery anastomosis and background risk factors or surgical methods, and to determine whether such necrosis is predictable or avoidable.


METHODS
Forty-seven patients (a total of 51 sides) with atherosclerotic lesions of the internal carotid artery or middle cerebral artery who underwent superficial temporal artery-to-middle cerebral artery anastomosis at the National Kyushu Medical Center Hospital between September 1, 1994, and August 31, 1999, were reviewed. Each procedure was analyzed to determine whether cutaneous necrosis was present postoperatively around the donor site, whether preexisting risk factors (hypertension, diabetes mellitus, hyperlipidemia, ischemic heart disease, and arteriosclerosis obliterans) were present, and whether a flap or cutdown method or a single or double anastomosis was performed.


RESULTS
Postoperative necrosis was clearly related to arteriosclerosis obliterans (P < 0.003). The tendency for a relationship between necrosis and smoking was noted. Although statistical analysis failed to demonstrate a significant difference, necrosis was found with the flap method but not with the cutdown method.


CONCLUSIONS
Further study is needed using greater numbers to clarify the relationship between the surgical method and the presence of necrosis. To prevent cutaneous necrosis, however, it may be preferable to use the cutdown method in patients with the preexisting risk factors of arteriosclerosis obliterans or in smokers.
Katsuta
T
T
Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center Hospital, Fukuoka, Japan. katsuta@uresino.hosp.go.jp
Inoue
T
T
Arakawa
S
S
Uda
K
K
D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000601:surgery; D002548:Cerebral Revascularization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D012867:Skin / Q000098:blood supply* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects; D013536:Suture Techniques