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.