The use of fibrin glue to stabilize geometry of free-flaps vascular pedicle

Excerpt

Free microvascular flaps of the head and neck provide complex and extensive reconstructions, resulting in predictable functional and esthetic outcomes. External compression, torsion, tension of the anastomosis site, and kinking of the pedicle must be avoided to assure the success of free tissue transfers. Head rotation significantly alters the initial position of the vascular pedicle. However head and neck are mobile in three dimensions and difficult to complete immobilize; in spite of some precautions, as rotating the head contralateral for the first few days postoperatively or shortening the pedicle, flaps crises and failures occur more frequently than other sites [1]. The postoperative vascular problems due to kinking or torsion result more frequently from improper positioning than anastomotic technique. The geometry of the vascular pedicle [2] is a very crucial parameter and recipient vessels selection is a major determining factor in the achievement of it. Preoperative planning must include detailed attention to the technical aspects of the microvascular procedure: cervical vascular anatomy, vascular anatomy of the various flaps including pedicle lengths, and a knowledge of how to facilitate microvascular surgery in the neck. Positioning the vessels in a longitudinal direction helps to eliminate the risk of kinking at the side-to-side movements of the head, it is equally important to prevent tension, avoiding very short pedicles and redundancy, and shortening the vessels including loops. [3] It is also important to return the head and neck to a normal position, sometimes with slight flexion, and inspect the placement of the vascular pedicle again before closure. …