Although major branches of the external carotid artery such as the facial and the superior thyroid provide the majority of recipient vessels in microvascular head and neck reconstruction, anatomic issues, vessel availability, and the technical aspects of the reconstruction often preclude the selection of these vessels. This chapter discusses the general considerations and technical details, and provides a framework for successful vessel management for microvascular free tissue transfer in the head and neck. ♦ Heparinized saline (100 U/mL) is used for irrigation and visualization and prevention of thrombosis during microsurgery. Class IV—involve more than one subsite, adverse features. (A) The least desirable situation, with two vascular kink points. Heiligers, Ludi E. Smeele The favoured method of reconstruction for large head and neck defects after resection for cancer is microvascular free flaps. Additional vessel preparation may be required in special circumstances such as vein grafting, application of monitoring devices, or for certain vessel configurations. Fig. For example, a scalp reconstruction in Zone I may in fact also have recipient vessels in Zone I (i.e., superficial temporal artery/vein); however, a fibular reconstruction of the mandible (zone I) is likely to have recipient vessels selected within Zone II or III. Essentially, arterial donor vessels may be divided into two categories: branches of the external carotid and branches of the thyrocervical trunk (Fig. Although the routine use of preoperative imaging in the surgical planning for ablative surgery is widely accepted, preoperative imaging obtained specifically for microvascular surgery is often unnecessary. The most obvious are related to vascular compromise of the flap. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The development and refinement of microvascular instruments and … Postoperative complications are common, which often leads to prolonged hospital stay. Pedicle length and diameter match with proposed recipient sites should be planned prior to flap inset. Pedicle length and diameter match with proposed recipient sites should be planned prior to flap inset. 10.2 Vessel geometry is exceptionally important. Some detailed considerations of the recipient zones follow. Planning for double free tissue transfers requires further attention by the microsurgeon to avoid technical difficulties related to pedicle geometry and vessel availability. Nevertheless, microvascular surgeons have multiple vascular donor options within the head and neck for microvascular surgery. The thyrocervical system represents the ideal arterial system for microvascular surgeon in the vessel-depleted neck. There are, however, several situations in which imaging is indicated prior to reconstruction. ♦ Careful planning for double free tissue transfers will avoid unnecessary technical difficulties during microsurgery. Reconstructive Implications for Vessel Orientation, pedicle curvature with alignment of the microvascular anastomosis (. It has been previously established as superior to conventional care for a wide variety of procedures, including microsurgical procedures such as reconstructions of the breast. 10 Prior to arterial division within this region the surgeon should verify that a branching pattern exists on the proposed recipient artery as the vertebral artery arises slightly medial to the origin of the thyrocervical trunk from the subclavian artery and may inadvertently be damaged, with severe consequences. Advantages of this recipient site include avoiding previously radiated areas, good anatomic reliability, and the avoidance of vein grafting for reconstructions of this region. (B) A moderate risk, with one vascular kink point. The length of the vascular pedicle determines the optimal donor-recipient relationship. ♦ Radiated/thickened vessels may require additional preparation to provide optimal vessel wall thickness for accurate anastomosis. Microvascular head and neck reconstructive surgery is a medical technique for rebuilding the neck and facial tissues of the body. Location of these vessels is readily achieved by palpation of the mandibular notch and careful dissection to identify the vessels for vascular access as well as to identify and protect the marginal branch of the facial nerve, which overlies the facial vein in this region. © 2020 The Authors. Head and Neck Surgery with Microvascular Flap Reconstruction What is head and neck surgery with microvascular flap reconstruction? 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