Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Abstract

Background Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels.

Methods We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels.

Results A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates.

Conclusion Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.

Keywords

fibula flap - microsurgery - superficial temporal

Ethical Statement

The Chang Gung Medical Foundation Institutional Review Board approved this study (IRB: 202100767B0), waiving the need for consent from study participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Chang Gung Medical Foundation Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent form for patient photographs was obtained from all individuals and the authors will provide it if requested.

^* Co-first authors—these authors worked together on the manuscript and contributed equally.

Publikationsverlauf

Eingereicht: 22. September 2021

Angenommen: 27. Dezember 2021

Artikel online veröffentlicht:
25. Februar 2022

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