Sleeve anastomosis in head and neck reconstruction

Various methods have been described in the literature to manage vascular discrepancies. In the head and neck area, where small recipient vessels are the rule, a reliable technique is needed to safely perform the anastomosis. During the past 10 years, we have carried out research (de la Peña et al., Transactions of the American Society for Reconstructive Surgery, Orlando, FL, Sept. 1991) on fresh cadavers; we have shown that the average outer diameter for the superficial temporal artery in Mexican adults varies from 1.7 to 2.4 mm, while the arteries for the most commonly used free flaps are double or triple this size. Other recipient arteries-facial, superior thyroid, and transverse cervical-are larger in diameter but still smaller than most free flap pedicles. Variations of Lauritzen's first technical description (Lauritzen, Scand J Plast Reconstr Surg 12:291-294, 1978) of the sleeve anastomosis have been reported, but they have not been evaluated for resolving vascular size discrepancies in the head and neck area. We evaluated 25 free flaps transferred to the head and neck area, using the sleeve anastomosis in either arteries, veins, or vein grafts. Out of 28 arterial telescoping anastomoses, including two vein grafts, only one thrombosis appeared. It was revised with no harm to the flap. In six venous sleeve anastomoses one required intraoperative revision, with 100% success. All the vessels had more than 2.5:1 vascular size discrepancies managed successfully with this technique.