Arterial blood flow changes after free tissue transfer in head and neck reconstruction

The authors measured pedicle arterial flow volume output using color Doppler ultrasonography in 23 patients after free tissue transfer in head and neck reconstruction.

Transferred flaps included six free jejunums, eight free radial forearm flaps, and four anterolateral thigh flaps. Flow volume output could be measured on all patients and was selectively measured in 17 patients with color Doppler ultrasonography on days 1, 4, 7, 14, 21, and 28 after surgery. The authors compared output change in different periods. In addition, they compared flow volume output on the first postoperative day in the different flaps and in the different recipient arteries and veins, and the effectiveness of irradiation in the different patients.

Three of the 17 patients developed venous thrombosis. Flow volume output on the skin flaps increased gradually from day 1 to 7 after surgery and decreased gradually until day 28 in 14 patients without venous thrombosis. The free jejunum had more pedicle arterial blood flow than the skin flaps and it showed minimal flow volume output change. There were no significant differences among different recipient vessels or different skin flaps, or in the effectiveness of irradiation in the different patients. Three patients who developed venous thrombosis were salvaged by reanastomoses of the thrombosed vein.

Before reanastomosis, abnormal arterial waveform, decreasing flow volume output, and a lack of venous blood flow were observed in the patients who developed venous thrombosis. After reanastomoses, the output was significantly improved and the flaps survived completely in all three cases. The authors conclude that color Doppler ultrasonography is useful for detecting venous thromboses too.