Discussion
head and neck reconstruction
SECONDARY, ADVANCED CANCER, COMPLICATIONS
Few articles have specifically compared the postoperative results based on the choice of the recipient vessels in midface and scalp microvascular reconstruction.The superficial temporal vessels are readily available, and their suitability as recipient vessels for microvascular free tissue flap in head and neck reconstruction has been reported by numerous authors.Although there was no significant difference in the rate of total flap loss between the 2 groups in our series, the rate of complications was nevertheless higher in patients with superficial temporal recipient vessels than in those with cervical recipient vessels. It is important to emphasize that, of the 4 patients who had microvascular anastomosis complications, three were undergoing secondary free tissue flap reconstruction, due to previous total flap loss. In our series, the overall flap survival rate was 88.89%. These data are similar to other available series reporting above 90% of success in free flaps for advanced cases.Wang et al.Our study is not without limitations. First, selection bias could have been an issue, since the main author did patient allocation. Even though, we cannot completely exclude this systematic error, our statistical results indicate that groups were similar in each and every domain, so minimizing the effect of patient selection. Finally, sample size is not expressive, but proved adequate on statistical analysis. It is worth considering the rarity of such advanced cancers of the midface and scalp, even in reference centers, like ours, resulting in very large surgical defects and demanding very complex reconstructions. Our results should be validated in large multicenter studies. On the other hand, our study is the first randomized study in the field providing further support for the use of superficial temporal vessels in such difficult cases of midface and scalp advanced oncologic reconstruction.