Concept of successful execution of microvascular tissue transfer in the head and neck region: "Keep it simple, stupid"

Introduction Microvascular transfer of free tissue is an established and equally challenging procedure, associated with graft failure in 1-9 %  of cases. The surgical approach as well as peri- and postoperative management are subject to great interindividual and interinstitutional variability. This study presents a standardised, simple concept of management.

Methods Retrospective analysis of all procedures with free tissue transfers with regard to the type of graft, suture technique and graft-related early complications. Description of the intra-, peri- and postoperative approach.

Results From 08/2017 to 11/2020, 91 soft tissue grafts were transplanted in the head and neck region. The defect was pharyngolaryngeal or in the oral cavity in 75 %  of cases, in 25 %  the defect was located in the face or neck surface. A total of 47 ALT-, 40 forearm-, three SCIP- and one Latissimus dorsi-flap were used. In all cases, the arterial anastomosis was carried out with nylon thread using the end-to-end single button technique. 54 %  of venous anastomoses were executed using a vein coupler, and in 63 %  of the cases two venous anastomoses were applied. A standard pre- and postoperative thrombosis prophylaxis with Clexane was given, however, no intraoperative administration of heparin was performed. The flap monitoring was carried out by clinical inspection and vascular doppler. In no case an anastomotic revision necessary. There was also no transplant loss. In one case a small marginal necrosis occurred.

Discussion When well-performed microvascular tissue transfer is complemented with an simple yet effective peri- and postoperative management concept, excellent success rates can be achieved, regardless of the type of transplant or defect.

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publication History

Article published online:
13 May 2021