Minimizing morbidity in microvascular surgery: small-caliber anastomotic vessels and minimal access approaches.

IMPORTANCE Minimizing morbidity when performing free flap reconstruction of the head and neck is important in the overall reconstructive paradigm. OBJECTIVE To examine the indications and success rates of free tissue transfer using small-caliber facial recipient vessels and minimal access incisions. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of patients with head and neck defects undergoing free tissue transfer from May 2010 to June 2013 at 2 tertiary care academic medical centers. INTERVENTIONS Free tissue transfer using small-caliber recipient vessels and minimal access approaches. MAIN OUTCOMES AND MEASURES Postoperative complications, including flap failure, requirement for revision surgery, and nerve dysfunction. RESULTS Eighty-nine flaps in 86 patients met inclusion criteria. Fifty flaps used the facial artery and vein distal to the facial notch, and 33 flaps used the superficial temporal vascular system. Six flaps used the angular artery and vein. A variety of flap donor sites were included. In most cases, free tissue transfer was indicated for the reconstruction of defects secondary to extirpation of malignant neoplasia. Overall success rate was 97.7% with 2 instances of total flap loss and 1 partial loss. One patient had transient nerve weakness (frontal branch), which resolved during a follow-up of 9 months. CONCLUSIONS AND RELEVANCE Free tissue reconstruction of head and neck defects can be safely and reliably accomplished using small-caliber recipient vessels, such as the superficial temporal, distal facial, and angular vessels. Minimal access approaches for microvascular anastomosis may be performed with excellent cosmesis and minimal morbidity. LEVEL OF EVIDENCE 4.