Microvascular tissue transfer in the head and neck has been well described for reconstruction following tumor extirpation, trauma, and congenital defects. Over time, a daunting number of flaps have been consolidated into a limited number of “workhorse” flaps, which are successfully used for the majority of reconstructions.1–3 Similarly, optimal recipient vessels have been well characterized for a variety of defects, such as microvascular free flap breast reconstruction.4,5 For head and neck reconstruction, common choices for recipient vessels are those located in the ipsilateral neck. Multiple options exist for both arterial and venous anastomoses, including the common facial trunk, superior thyroid, and transverse cervical arteries, and the corresponding venous drainage systems.3,6,7
Reports of microvascular free tissue transfer to the superficial temporal artery and vein are limited other than our reports for the correction of contour deformities in the face.8 Hussussian and Reece report limited use of the superficial temporal vessels, citing the insufficient caliber of the vein. They more commonly use the external carotid artery and internal jugular vein for scalp reconstruction.9 Hansen et al. describe the use of the superficial temporal artery and vein in 43 patients, Nahabedian et al. describe its use in 23 patients, and Oh et al. report its use in 14 patients.6,10,11
Since 1989, our preferred recipient vessels in over 400 cases for facial microsurgery have been the superficial temporal artery and vein.12 The objective of this report is to describe our surgical approach to the superficial temporal artery and vein and highlight key technical considerations to maximize success.
The anatomical course of the superficial temporal vessels has been well described. The superficial temporal artery is a terminal branch of the external carotid artery. It bifurcates into two branches: the frontal and parietal branches. The superficial temporal vein is more variable, and can have multiple branching patterns.13
The superficial temporal artery and vein are dissected by means of a preauricular incision similar to a pretragal face-lift incision. The superficial layers are elevated to expose the superficial temporal vein branches, which are located superficial to the superficial temporal artery branches. The superficial temporal vein branches are dissected proximally to the point where the venous branches join the main superficial temporal vein. Branches of the auriculotemporal sensory nerve run with the vascular branches (Fig. 1). The superficial temporal artery branches will be found deep to the superficial temporal vein branches in front of the ear (Fig. 2, left). Tracing these branches more proximally reveals a point where the superficial temporal artery and vein lie at the same anatomical depth (Fig. 2, center). This is usually found at the cephalad edge of the parotid gland. Both the superficial temporal artery and vein are dissected proximally into the parenchyma of the parotid gland with bipolar until the vessels are approximately 2 mm in diameter, usually at a level just inferior to the ear tragus (Fig. 2, right). Vasodilation with topical papaverine or 4% lidocaine applied directly to the vessels and coverage with neuropatties is helpful until microsurgical anastomoses are performed. Following this protocol will result in consistent microsurgical anastomoses with superficial temporal vessels between 2.0 and 2.5 mm in diameter. We have found many cases where the superficial temporal vessels initially appear to have inadequate diameters for successful anastomoses. However, if dissected into the parotid gland, both the artery and vein will be of sufficient caliber (Fig. 3). Both the artery and vein dive deeper into the parenchyma, and thus anastomosis is usually performed in a vertical orientation to the vessel. In addition, the superficial temporal vein is extremely thin walled in most patients. These two conditions make it necessary to hand sew the anastomosis and, in many cases, heparinized saline must be used to open the venous end by immersion. After successful anastomoses, a trough is made with electrocautery in the parotid gland so that no kinking of the anastomoses or the vessels will occur. In only one case was an inadequate superficial temporal vein found within the parotid gland necessitating transposition of a postauricular vein for venous anastomosis adjacent to the superficial temporal artery anastomosis.
The authors have no financial interest to declare in relation to the content of this article.
Jenny Tzujane Chen, M.D.
Ruston Sanchez, M.D.
Ravi Garg, M.D.
Samuel Poore, M.D.
John W. Siebert, M.D.
Division of Plastic and Reconstructive Surgery
University of Wisconsin School of Medicine and Public Health
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