Selection of appropriate recipient vessels in difficult, microsurgical head and neck reconstruction

In a series of 327 cases of head and neck microsurgical reconstruction during 22 years beginning in 1974, the authors have reviewed 16 cases in which the first choice of recipient vessels was not available. The problems of selecting alternative and appropriate recipient vessels are discussed. Recipient vessels could be classified into three groups: adjacent small vessels that are usually considered to be the first choice; major vessels; and distant vessels. A correlation between the selection of substitute vessels and the region of reconstruction was found. Representative cases in each category are presented. In difficult cases in freeflap transfer, it is of prime importance to select healthy recipient vessels. Additionally, special precautions, including choice of anastomotic technique, are required.