Microvascular surgery - does size matter
Reviewed by Bilal Gani Taib

Success rates for microvascular free tissue transfer performed for head and neck reconstruction are currently very high. As the recipient vessel diameter decreases, questions of reliability and ease of access are raised. This retrospective analysis looked at 89 flaps in 86 patients. Fifty flaps used the facial artery and vein distal to the facial vein notch, and 33 flaps used the superficial temporal vasculature system. Six flaps used the angular artery and vein. The overall success rate was 97.7% with two instances of complete flap loss. One of these was due to a patient independently wearing an occlusive dressing over the site and the second was thought to be due to the fact the site of reconstruction was a heavily irradiated area. This paper adds weight to the belief that reconstruction of defects in the central and upper third of the face can be reliably accomplished using smaller-calibre vessels, such as the superficial temporal, distal facial and angular vessels. Minimal access incisions permit microvascular anastomosis with improved cosmesis and minimal nerve dysfunction.

Minimising morbidity in microvascular surgery – small caliber anastomotic vessels and minimal access approaches.
Revenaugh PC, Fritz MA, Haffey TM, Seth R, Markey J, Knott PD.
JAMA FACIAL PLASTIC SURGERY
2015;17(1):44-8.