An algorithm for recipient vessel selection in microsurgical head and neck reconstruction.
This article details an algorithm we used for selection of recipient vessels in free tissue transfer to the head and neck. Eighty-eight consecutive free flaps to the head and neck were performed in 85 patients. The superior thyroid was the commonest recipient artery used (61%). The facial artery, used in 14% of our cases, is the choice vessel in instances where neck dissection is not performed. In these cases, we have to access the neck separately for recipient vessels and it can be exposed easily via a short (3-cm) incision. The superficial temporal artery (11%) is our choice vessel for patients with previous neck dissection or radiotherapy as it is well outside the previous operative or irradiated field. Other vessels such as the transverse cervical and end-to-side anastomosis to the carotid artery were also used when appropriate. Recipient vein selection depends primarily on the selected artery. Corresponding veins and large branches of the internal jugular vein (IJV) in the vicinity of the selected artery are preferred. When these are exhausted, the external jugular vein and end-to-side anastomosis to the IJV are considered. We found this algorithm to be reliable in identifying the appropriate vessels in all cases.
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
Hui-Ling
HL
Chia
Chin-Ho
CH
Wong
Bien-Keem
BK
Tan
Kok-Chai
KC
Tan
Yee-Siang
YS
Ong
D000328:Adult; D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical; D001158:Arteries; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013699:Temporal Arteries; D013961:Thyroid Gland / Q000098:blood supply; D055815:Young Adult