Superficial temporal vessels, both anterograde and retrograde limbs, are viable recipient vessels for recurrent head and neck reconstruction in patients with frozen neck

Abstract

Background Reconstruction of recurrent head and neck malignancy especially in the presence of a frozen neck is challenging. The superficial temporal vessels would be ideal as recipient vessels because they lie out of the previous surgical and radiation field. Methods We conducted a retrospective case‐control study based on our database between January 2013 and June 2016. A total of 581 primary cases were selected as controls. The 60 test group patients had (a) recurrent head and neck reconstruction, (b) previous surgery and irradiation, (c) frozen neck, and (d) superficial temporal vessels as recipients. Results There was no significant difference between vascular compromise rates of superficial temporal vessels (anterograde and retrograde limbs) and controls (P > .05). Flap success rate of the test and control group is comparable, 95% vs 98% respectively. Conclusion Superficial temporal vessels, both anterograde and retrograde, should be the first consideration for recurrent intraoral, facial, and scalp reconstruction with frozen necks.

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

“…This probably is because ST vessels are less affected by radiation as they are located some distance away from the center of radiation and, therefore, relatively healthy as recipient vessels. 11,12 Even though there was no increase in the take-back rate in our series, we should not rule it out due to the limited number of cases.…”

“…The overall free flap success rate was high (98.5%), which is in accordance with data reported by several high-volume centers. 10 12 14 16 This success rate is noted given the high-risk profile of the patients characterized by a low proportion of primary cases and the high prevalence of previous treatments, particularly radiotherapy (70.5%), neck dissection (87.1%), and free flap reconstruction (80.3% of the patients had at least one).…”

“…13 14 15 16 17 18 Besides this, several authors recommend using ST vessels when patients have been submitted to previous neck dissection (which may compromise potential recipient vessels and cause scarring making their dissection in the neck more difficult) or neck radiotherapy since they are located away from the irradiated field and theoretically spared from direct radiation damage. 10 11 12…”

“…[1][2][3]7,8 Successful outcomes have also been reported using the superficial temporal (ST) vessels as recipient vessels for microsurgical reconstruction. [9][10][11][12] Most articles report their use in scalp and orbital reconstruction, where they are frequently considered a first option due to their proximity to the defects and their stable anatomical position in the pretragal zone. [13][14][15][16][17][18] Besides this, several authors recommend using ST vessels when patients have been submitted to previous neck dissection (which may compromise potential recipient vessels and cause scarring making their dissection in the neck more difficult) or neck radiotherapy since they are located away from the irradiated field and theoretically spared from direct radiation damage.…”

“…[13][14][15][16][17][18] Besides this, several authors recommend using ST vessels when patients have been submitted to previous neck dissection (which may compromise potential recipient vessels and cause scarring making their dissection in the neck more difficult) or neck radiotherapy since they are located away from the irradiated field and theoretically spared from direct radiation damage. [10][11][12] However, some authors recommend a cautious approach when using these vessels, stating their small caliber, an artery easily prone to spasm, and a thin-walled vein as potential risk factors for failure, flap complications, and increasing the difficulty of the reconstruction. 15,17,19,20 The main goal of this study was to review our experience of using the ST vessels in H&N reconstruction, including flap failure and take-back rates, analyzing the reasons behind flap urgent re-exploration and techniques used to overcome the problems encountered.…”