Results
thrombosis, squamous cell carcinoma of the left midface, venous thrombosis, microvascular vascular anastomosis obstruction
THROMBOSIS, ARTERIAL THROMBOSIS, GROUP B, MINOR, RECRUITMENT, COMPLICATION, VENOUS THROMBOSIS, COMPLICATIONS, ARTERIAL THROMBOSIS
Thirty-two patients were selected and randomized into two groups. Five patients were excluded from the study. The total study period was developed prospectively over 4 years (from April 2018 to April 2022) with the recruitment period occurring during the initial 45 months. The minimum follow-up of the patients was 3 months, enough time to assess major and minor complications. The diagram describes the participants flow (Study design.Patients characteristics and type of free tissue flap.ALTF, Anterolateral Thigh Flap; RAF, (A) Pre-operative aspect of an advanced squamous cell carcinoma of the left midface. (B) The cervical recipient vessels: single asterisk demonstrates the microanastomosis of facial vein with the flap vein and double asterisk demonstrates the microanastomosis of facial artery with the flap artery. (C) The late post-operative aspect of an anterolateral thigh free flap inserted in the surgical site.(A) Per-operative aspect of an extended right orbit exenteration due an advanced cutaneous squamous cell carcinoma. (B) The superficial temporal recipient vessels demonstrate the microanastomosis of the superficial temporal vein with the flap vein (single asterisk) and the double asterisk demonstrates the microanastomosis of the superficial temporal artery with the flap artery. (C) The late post-operative aspect of an anterolateral thigh free flap inserted in the right midface.In Group B, the following recipient arteries were used: facial artery (n = 9), superior thyroid artery (n = 4), and lingual artery (n = 2). The recipient cervical veins used in this group were: facial vein (n = 11) and internal jugular vein (n = 4). Vein grafts were not used. All microanastomosis were performed in an end-to-end fashion except for four cases, in which the anastomosis with the internal jugular vein were performed using an end-to-side technique. Only one patient in Group B required early return to the operating room due to microvascular vascular anastomosis obstruction, with successful resolution. Arterial thrombosis developed in one patient in Group B on the 2nd postoperative day, with total flaps loss. Two patients in Group A suffered total flap loss: one due to venous thrombosis on the 3rd postoperative day, and one due to arterial thrombosis on the 5th postoperative day. Both patients underwent a late successful reconstruction with another free tissue flap. No other major complications occurred in this group.In the present series, the overall flap survival rate was 88.89% (24 of 27 flaps). All major complications involved microvascular thrombosis, with a complication rate of 14.81% (4 of 27 patients). Of the three patients who developed total flap loss, two were in Group A (16.67%) and one was in Group B (6.66%), not significant (Characteristics of the technical aspects and complications of free tissue flaps in both groups.