The use of superficial temporal vessels as free flap recipients in head and neck reconstruction. Systematic review, cadaver dissection and clinical experience.

Background
Superficial temporal (ST) vessels have classically been source of doubts and fears regarding their reliability as recipient vessels in head and neck (H&N) reconstruction1. The last years, though, have seen a notable increase in their use for this purpose, with growing evidence suggesting they are as safe as any other recipient vessel in the region.

Materials and methods
We conducted two systematic reviews, one on their surgical outcomes as free flap recipients and the other on their anatomic characteristics, both following PRISMA2020 guidelines. These were complemented with 15 cadaver dissections and a 40-patient case-series, contrasting our evidence with the published literature. Data analysis was performed using SPSS.

Results
ST vessels are as reliable as other recipient vessels in the H&N region, with mean flap survival rates of 97.84% (overall reported rates of free flap survival in H&N reconstruction ranging from 95 to 98%)2. According to literature, one can expect an arterial diameter of 1'98 ± 0'30 mm at the level of the zygoma and 2'32 ± 0'24 mm at the vessel's origin, translating a percentual increase of 5'7 - 8'6% for every 1 mm of proximal dissection3,4. Our cadaver study and clinical experience support this evidence.

Conclusions
The superficial temporal vessels are safe and reliable as free flap recipients in H&N reconstruction, showing a flap survival rate equivalent to the one reported in the literature for any other recipient vessel. Both the published literature and our cadaver study demonstrate they have a suitable anatomy to serve as recipient vessels.


1. Mata Ribeiro, Luís, Chung-Kan Tsao, Yu-Liang Hung, Chun-Hui Chu, Li-Ching Lin, Mo-Han Lin, Chi Peng, David Chon-Fok Cheong, Shao-Yu Hung, and Chun-Ta Liao. 2022. 'Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps'. Journal of Reconstructive Microsurgery 38(08):654–63. doi: 10.1055/s-0042-1743165.
2. Groth AK, Ono MCC, D'Avanço de Morais A, et al. Superficial temporal vessels as a recipient site for microvascular head and neck reconstruction: Is it reliable? Eur J Plast Surg. 2020;43(2):117-122. doi: 10.1007/s00238-019-01569-z.
3. Medved F, Manoli T, Medesan R, et al. In vivo analysis of the vascular pattern of the superficial temporal artery based on digital subtraction angiography. Microsurgery. 2015;35(5):380-386. doi: 10.1002/micr.22348.
4. Manoli T, Medesan R, Held M, et al. Bilateral comparison of the vascular pattern of the superficial temporal artery based on digital subtraction angiography. Surg Radiol Anat. 2016;38(2):179-186. doi: 10.1007/s00276-015-1538-0.

Craniomaxillofacial/Head and Neck

PSTM 2024