Artery first and declamp it: A temporary revascularization method during microvascular anastomosis: A retrospective...

Area of Science:

• Microsurgery
• Plastic Surgery
• Head and Neck Reconstruction

Background:

• Optimal microvascular clamping sequence in free flap transfer remains undetermined.
• Surgeons often avoid temporary declamping/reclamping during microvascular anastomosis.
• Current practice involves arterial anastomosis first, followed by temporary declamping to ensure patency and vein alignment.

Purpose of the Study:

• To retrospectively investigate the efficacy and safety of temporary revascularization.
• To assess the impact of this method on microvascular head and neck reconstruction outcomes.

Main Methods:

• Retrospective analysis of 126 patients undergoing microvascular head and neck reconstruction.
• 127 free flaps transferred, predominantly anterolateral thigh flaps.
• Internal jugular vein used as recipient vein in 112 patients with end-to-side anastomoses.

Main Results:

• All flaps survived postoperatively without microvascular compromise.
• Intraoperative reanastomosis was needed for arterial thrombosis (4.0%) and other rare complications (0.8% each).

Conclusions:

• Temporary revascularization engorges flap veins, reducing venous kinking/twisting risk.
• Reclamping did not elevate the risk of arterial thrombosis in this cohort.
• This technique enhances free flap success in head and neck reconstruction.