Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Microsurgery. 2024 Sep;44(6):e31232. doi: 10.1002/micr.31232.
Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects.
A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported.
Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses.
When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.
在头颈部游离组织转移（FTT）重建中，如果无法实现无张力吻合，血管移植是一种重要的技术。据我们所知，关于头颈部重建中动脉吻合的中间动脉移植物的数据有限。在这里，我们介绍了多机构队列的头颈部缺损游离组织重建的动脉中间动脉移植物。
对四家三级医疗机构接受 FTT 重建的患者进行了回顾性分析，这些患者的动脉吻合采用了中间动脉移植物。对采集的动脉移植物的类型和长度、手术指征、动脉移植物的指征、采集的皮瓣类型以及各种术前特征（包括放疗史或既往 FTT 重建手术史）进行了回顾。报告并测量了术后 30 天内的术后并发症。
9 例患者符合纳入标准。旋股外侧动脉（横支或降支）（n=3）和面动脉（n=3）是最常采集的动脉。头皮（n=5）是最常见的原发缺损部位。7 个移植物是最初和计划中采集的，而 2 个是作为挽救技术采集的（要么是为了皮瓣挽救，要么是静脉移植物失败）。在计划的移植物中，由于移植物和受体动脉之间的尺寸匹配偏好（n=4）或壁厚度相似性（n=3），动脉是首选的中间移植物方法。没有报告计划外再入院、术后血肿、瘘管形成、伤口感染或供体部位并发症的病例。2 例患者因皮瓣受损需要计划外返回手术室，这 2 例患者最终因动脉和静脉吻合处均形成血栓而导致皮瓣失败。
当动脉蒂长度不足时，中间动脉移植是一种可行的技术，可以实现高度复杂的头颈部游离组织重建中选定病例的无张力动脉吻合。
