Share this article on:

Helpful Hints for the Superficial Temporal Artery and Vein as Recipient Vessels

Chen, Jenny Tzujane M.D.; Sanchez, Ruston M.D.; Garg, Ravi M.D.; Poore, Samuel M.D.; Siebert, John W. M.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 818e–820e
doi: 10.1097/PRS.0000000000003081

Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.

Correspondence to Dr. Siebert, Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, G5/354 CSC 600 Highland Avenue, Madison, Wis. 53792-3236,

Back to Top | Article Outline


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.

Fig. 1

Fig. 1

Fig. 2

Fig. 2

Fig. 3

Fig. 3

Back to Top | Article Outline


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

Madison, Wis.

Back to Top | Article Outline


1. Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PGSimplifying microvascular head and neck reconstruction: A rational approach to donor site selection.Ann Plast Surg200147385–389
2. Cordeiro PG, Disa JJChallenges in midface reconstruction.Semin Surg Oncol200019218–225
3. Wong CH, Wei FCMicrosurgical free flap in head and neck reconstruction.Head Neck2010321236–1245
4. Chang EI, Chang EI, Soto-Miranda MA, Nosrati N, Robb GL, Chang DWDemystifying the use of internal mammary vessels as recipient vessels in free flap breast reconstruction.Plast Reconstr Surg2013132763–768
5. Saint-Cyr M, Youssef A, Bae HW, Robb GL, Chang DWChanging trends in recipient vessel selection for microvascular autologous breast reconstruction: An analysis of 1483 consecutive cases.Plast Reconstr Surg20071191993–2000
6. Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro APRecipient vessel analysis for microvascular reconstruction of the head and neck.Ann Plast Surg200452148–155; discussion 156
7. Chalian AA, Anderson TD, Weinstein GS, Weber RSInternal jugular vein versus external jugular vein anastomosis: Implications for successful free tissue transfer.Head Neck200123475–478
8. Saadeh PB, Chang CC, Warren SM, Reavey P, McCarthy JG, Siebert JWMicrosurgical correction of facial contour deformities in patients with craniofacial malformations: A 15-year experience.Plast Reconstr Surg2008121368e–378e
9. Hussussian CJ, Reece GPMicrosurgical scalp reconstruction in the patient with cancer.Plast Reconstr Surg20021091828–1834
10. Hansen SL, Foster RD, Dosanjh AS, Mathes SJ, Hoffman WY, Leon PSuperficial temporal artery and vein as recipient vessels for facial and scalp microsurgical reconstruction.Plast Reconstr Surg20071201879–1884
11. Oh SJ, Lee J, Cha J, Jeon MK, Koh SH, Chung CHFree-flap reconstruction of the scalp: Donor selection and outcome.J Craniofac Surg201122974–977
12. Longaker MT, Siebert JWMicrovascular free-flap correction of severe hemifacial atrophy.Plast Reconstr Surg199596800–809
13. Imanishi N, Nakajima H, Minabe T, Chang H, Aiso SVenous drainage architecture of the temporal and parietal regions: Anatomy of the superficial temporal artery and vein.Plast Reconstr Surg20021092197–2203
Back to Top | Article Outline


Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

  • Text—maximum of 500 words (not including references)
  • References—maximum of five
  • Authors—no more than five
  • Figures/Tables—no more than two figures and/or one table

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2017American Society of Plastic Surgeons