Analysis of Recipient Vessel for Microvascular Reconstruction of the Head and Neck

Joo, Young Hoon; Sun, Dong Il; Park, Jun Ook; Cho, Kwang Jae; Seo, Jae Hyun; Park, Jae Won; Nam, Seung Kyu; Kim, Min Sik

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to evaluate the relationship between the free flap compromise and the choice of recipient vessels, the method of venous anastomosis, the use of an interposition vein graft, and the number of venous anastomosis for microvascular anastomosis.
SUBJECTS AND METHOD
A retrospective review was carried out for 237 patients who underwent 247 microvascular free flap reconstructions after head and neck ablative surgery from October 1993 to July 2009. Flap donor sites included the radial forearm (n=187), anterolateral thigh (n=34), rectus abdominis (n=11), fibula (n=8), and lateral thigh (n=7).
RESULTS
The frequently used recipient artery included facial (66.4%), superior thyroid (17.8%), lingual (8.1%), transverse cervical (6.9%), and external carotid (0.8%). The recipient vein included facial (43.7%), external jugular (39.3%), superior thyroid (5.8%), anterior jugular (1.7%), and transverse cervical (0.7%). End-to-end venous anastomoses were completed in 230 flaps and end-to-side anastomoses in 14 flaps. Three patients had one end-to-end and one endto- side anastomoses. The interposition vein grafts were used in 3 cases. Dual venous anastomoses were performed in 48 cases and single anastomosis in 199 cases. Twenty-one (8.5%) cases of free flap compromise due to vascular obstruction were identified and 11 flaps were lost (4.5%) with an overall success rate of 95.5%. There was no relationship between free flap compromise and the choice of recipient artery (p=0.360) or vein (p=0.125), the method of venous anastomosis (p=0.683), the use of an interposition vein graft (p=0.595), and the number of venous anastomosis (p=0.076).
CONCLUSION
All vessels in the head and neck are potentially suitable for microvascular anastomoses. Flap compromise was not related to the method of venous anastomosis, the interposition vein graft or the number of venous anastomosis.