Recipient Vessel Selection in Head and Neck Reconstruction

Objective: Recipient vessel caliber may be the single most important variable for flow to free tissue transfer. We performed cadaveric dissection of the external carotid artery and its branches to analyze average diameter in order to determine an algorithm for recipient vessel selection in head and neck reconstruction. Methods: The external carotid artery and branches were exposed on 3 lightly embalmed male human cadavers, aged 82 to 85 years. Each vessel was dissected, and luminal diameters were recorded with calipers. Results: The proximal ECA had the greatest average diameter (4 ± 0.6 mm) and potential flow; followed by distal ECA (2.85 ± 0.4 mm) facial (2.0 ± 0.6 mm), lingual (1.65 ± 0.6 mm), superior thyroid (1 ± 0.3  mm), and superficial temporal (0.85 ± 0.4 mm). There was a trend towards size variation between sides of the same cadaver. Conclusion: The external carotid artery has the greatest internal diameter and potential blood flow. It should be considered, when feasible, especially for defects of the upper third of the head. For defects of the lower third, the facial artery and the lingual artery should be utilized before the smaller diameter superior thyroid artery. Vessel selection is more challenging in the setting of radiation therapy, complex trauma, and prior neck surgery. In these settings, it is useful to have knowledge of the vascular anatomy and an objective algorithm for recipient vessel selection.