Anterolateral thigh flap pedicle for interposition artery and vein grafts in head and neck reconstruction: A case report

Abstract

The selection of receiving vessels is one of the most critical steps in ensuring a successful outcome in microvascular surgery. The use of interposition grafts in microsurgery offers the surgeon valuable options when the free flaps vascular pedicles are too short to be anastomosed directly to the recipient vessels. Here, we present a case in which artery and vein grafts were used in microsurgical reconstruction of an anterior maxillary defect with an iliac free flap. As donor vessels, we used the descending branch of the lateral circumflex femoral artery and one of the two venae commitantes. The flap survived without major or minor complications. The anterolateral thigh flap pedicle allowed us to harvest safe, reliable grafts easily, with a suitable vessel length and diameter.

Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications

“…6 Selecting appropriate recipient vessels for patients who have undergone chemotherapy, radiation therapy and previous surgery or who require surgery with reconstruction to treat recurrent cancer or second primary cancer can be difficult. Several techniques that have been applied to obtain recipient vessels for free flaps in the neck of such patients include an interposition arteriovenous loop, 7 an initially transferred vascular pedicle for secondary microvascular anastmosis, 8 venous and arterial interposition 9 , thoracoacromial vessels, and cephalic vein interposition. [10][11][12] However, Nahabedian et al associated flap failure with interposition vein grafts.…”

Use of the descending branch of the lateral femoral circumflex vessels as a composite interposition graft in lower extremity reconstruction

“…Recently, there have been a few case reports successfully utilizing the descending branch of the lateral femoral circumflex vascular bundle as an interposition graft for free flaps in head and neck reconstruction. [4][5][6] The descending branch of the lateral femoral circumflex artery and venae comitantes are ideal donor vessels for lengthening a flap's vascular pedicle. Although there are variations with this pedicle and its perforators, 11,12 this should not pose much of an issue with the harvesting of the interposition graft.…”

“…An alternative to the vein graft is the use of a composite artery and vein graft for additional pedicle length. The use of the descending branch of the lateral femoral circumflex artery and venae comitantes has been described for head and neck reconstruction; [4][5][6] however, its use in lower extremity reconstruction has not been previously reported. This article describes the use of the descending branch of the lateral femoral circumflex artery and venae comitantes as an arteriovenous interposition graft in the reconstruction of a trauma-related lower extremity defect in an elderly patient.…”

Iliac crest free flap and submental island flap for maxillary reconstruction

“…Because of the short pedicle (as a result of the deep circumflex iliac arterial system) venous grafts are often needed to reach the recipient neck vessels, and an increase in complications is related to this. We recently proposed the elongation of the pedicle with an arteriovenous graft harvested from the anterolateral thigh flap pedicle [10].…”