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Superficial Temporal Artery and Vein as Recipient Vessels for scalp and facial Reconstruction: Radiographic Support for Underused Vessels
Ali Charafeddine, M.D., Matthew Doscher, Bradley Schif, Todd Miller, Richard Smith, Oren tepper, Evan Garfein.
Montefiore Medical Center - Albert Einstein College of Medicine, Bronx, NY, USA.
Background: The choice of recipient vessels for microsurgical reconstruction is based on proximity to the defect, vessel caliber, anatomic reliability, and ease of dissection. Traditionally, the superior thyroid artery and the facial artery have been the recipient arteries for microvascular flap reconstruction of the head and neck. . The superficial temporal artery and vein (STA/V) have been reserved for defects of the upper 1/3 of the head and when there is previous neck dissection or history of irradiation.
Methods: A retrospective analysis of all consecutive head and neck reconstructions using the STA/V by a single reconstructive surgeon over a three-year period was performed. Graft survival was followed and radiographic analysis using preoperative imaging was used to map both vessel diameter and distance to defect in a subset of patients. The diameter of the superficial temporal artery (before the first branch point) was compared to the diameter of the facial artery at the inferior border of the mandible. The distances from these arteries to a prototypical maxillectomy defect were compared and operative times over the course of the surgeon’s experience using the superficial artery and vein were recorded.
Results: Twenty-four patients had microsurgical reconstruction using the superficial temporal artery and vein, Reconstructed defects included the upper, middle and lower face. Anterolateral thigh, osseocutaneous fibula, radial forearm, serratus anterior, and vertical rectus abdominis flaps were used. 21 out of 24 veins were anastomosed using couplers between 1.5-2.5mm. The remaining three were hand sewn. Overall flap survival rate was 100% with one partial flap loss. There were two cases of venous congestion; one required revision with a vein graft and one required repositioning of the vein without revision. Radiographic analysis revealed average facial and temporal artery diameters of 1.58mm and 1.45mm, respectively. Average distance from facial artery to defect field was 64.63mm compared with 66.08mm for the temporal artery. There was no statistical significance between the diameters of the STA and of the FA or between the distances of the two vessels from the midface.
Conclusions: In our experience, the superficial temporal artery and vein have met all required criteria for use as recipient vessels in head and neck reconstruction. They are close to the site of defect, are of acceptable quality and caliber, have a predictable anatomic location, and are quickly and easily dissected. The pre-auricular incision is inconspicuous and readily reveals the vein lateral to and slightly deep to the artery. We recommend that the superficial temporal artery and vein to be considered recipient vessels-of-choice for reconstruction of defects of the mid-face, scalp, cheek and lateral oropharynx.
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