Outcomes for recipient vessel selection in head and neck free flap reconstruction: a retrospective cohort study

Microvascular free flap reconstruction is essential in head and neck reconstruction. Cervical recipient vessels are traditionally preferred, whereas temporal recipient vessels are increasingly used in selected cases. This study aimed to compare outcomes of temporally versus cervically anastomosed free flaps. A retrospective cohort study including 158 free flap reconstructions was conducted at a single center. Seventy-nine flaps were anastomosed to temporal recipient vessels and compared with a cohort of cervically anastomosed flaps during the same period. Baseline characteristics, perioperative variables, and postoperative outcomes were assessed. Primary outcomes were vascular revision and flap survival. Secondary outcomes included partial and total flap loss. Multivariable analyses accounted for anatomical defect localization and surgical complexity. Baseline characteristics were comparable between groups. Vascular revision of the microvascular anastomosis occurred in five out of 79 flaps (6%) in both cohorts (odds ratio 1.00, 95% confidence interval 0.28-3.60; P = 1.00). Total flap loss occurred in four out of 79 cervical cases (5%) and one out of 79 temporal cases (1%) (0.24, 0.03-2.20; P = 0.21). Operative time was shorter in the temporal group (P < 0.001), while ischemia time was comparable (P = 0.95). Temporally anastomosed patients had higher American Society of Anesthesiologists scores (P = 0.009), without increased medical complications or resource utilization. Temporal recipient vessels represent a safe and effective alternative to cervical vessels in head and neck free flap reconstruction. After accounting for anatomical defect localization and surgical complexity, recipient vessel location was not associated with differences in vascular revision or flap survival.