Sleeve anastomosis in head and neck reconstruction

Various methods have been described in the literature to manage vascular di screpancies. In the head and neck area, where small recipient vessels are t he rule, a reliable technique is needed to safely perform the anastomosis. During the past 10 years, we have carried out research (de la Pena et al,, Transactions of the American Society for Reconstructive Surgery, Orlando, F L, Sept. 1991) on fresh cadavers; we have shown that the average outer diam eter for the superficial temporal artery in Mexican adults varies from 1.7 to 2.4 mm, while the arteries for the most commonly used free flaps are dou ble or triple this size. Other recipient arteries-facial, superior thyroid, and transverse cervical-are larger in diameter but still smaller than most free flap pedicles, Variations of Lauritzen's first technical description (Lauritzen, Scand J Plast Reconstr Surg 12:291-294, 1978) of the sleeve ana stomosis have been reported, but they have not been evaluated for resolving vascular size discrepancies in the head and neck area. We evaluated 25 fre e flaps transferred to the head and neck area, using the sleeve anastomosis in either arteries, veins, or vein grafts. Out of 28 arterial telescoping anastomoses, including two vein grafts, only one thrombosis appeared. It wa s revised with no harm to the flap. In six venous sleeve anastomoses one re quired intraoperative revision, with 100% success. All the vessels had more than 2.5:1 vascular size discrepancies managed successfully with this tech nique. (C) 2000 Wiley-Liss, Inc.