Recipient vessel selection for multiple free flap transfers in head and neck reconstruction at different periods

Abstract

Background Treatment decisions can be challenging in patients undergoing multiple oropharyngeal microsurgical reconstructions at different periods by various causes. We, retrospectively, reviewed patients with at least three consecutive free flap reconstructions to determine the optimal strategy for selecting recipient vessels. Methods Then, 36 patients (33 men and 3 women) who underwent at least 3 microsurgical reconstructions with a total of 51 free flap transfers for head and neck defects were included in this report. The most common reason for multiple microsurgical reconstructions was recurrent disease. For reconstructions, recipient vessel candidates on the same side of the head and neck were prioritized; if ipsilateral vessels were unavailable, contralateral recipient vessels, which might necessitate vein grafts, were used. Results The most common reconstructions were anterolateral thigh flaps (19 cases). The most commonly used contralateral recipient vessels were the superior thyroid artery, facial artery, and external jugular vein. All vessel anastomoses were performed using the end‐to‐end method. Postoperative complications occurred at the sites of 26 free flap reconstructions. The overall flap reconstruction success rate in patients with at least three surgeries was 90.2%. The median follow‐up duration was 25.8 months. During follow‐up, 26 patients survived until the end of follow‐up. Conclusions In patients undergoing multiple free flap reconstructions, recipient vessels on the ipsilateral side that have not been subjected to radiation should be selected first. Recipient vessels contralateral to the reconstruction side can then be selected; however, they may require vein grafts. Finally, distant healthy recipient vessels can be selected through vein grafting.

Lingual Artery as the Recipient Vessel of Choice in Patients Requiring a Second or Third Free Flap in Recurrent Oral Cancers and Vessel-Depleted Neck: A 5-Year Experience in a Single Institute

“…Consequently, complication rates are also expected to be considerably high. 5 A crucial approach in such patients is determining the recipient vessels that are to be used for microvascular anastomosis since in these cases the neck becomes somewhat “vessel depleted.” In our study, selection of vein was not a problem as internal jugular vein was used in 17 cases, an intact external jugular vein in 3 cases, and flipped cephalic vein in 2 cases. Selection of recipient artery was pivotal in our series because of the following reasons:…”