Cutaneous necrosis after superficial temporal artery-to-middle cerebral artery anastomosis: Is it predictable or avoidable?

OBJECTIVE: This study was carried out to determine whether a relationship e xists between cutaneous necrosis after superficial temporal artery-to-middl e cerebral artery anastomosis and background risk factors or surgical metho ds, and to determine whether such necrosis is predictable or avoidable. METHODS: Forty-seven patients (a total of 51 sides) with atherosclerotic le sions of the internal carotid artery or middle cerebral artery who underwen t superficial temporal artery-to-middle cerebral artery anastomosis at the National Kyushu Medical Center Hospital between September 1, 1994, and Augu st 31, 1999, were reviewed. Each procedure was analyzed to determine whethe r cutaneous necrosis was present postoperatively around the donor site, whe ther preexisting risk factors (hypertension, diabetes mellitus, hyperlipide mia, ischemic heart disease, and arteriosclerosis obliterans) were present, and whether a flap or cutdown method or a single or double anastomosis was performed. RESULTS: Postoperative necrosis was clearly related to arteriosclerosis obl iterans (P < 0.003). The tendency for a relationship between necrosis and s moking was noted. Although statistical analysis failed to demonstrate a sig nificant difference, necrosis was found with the flap method but not with t he cutdown method. CONCLUSION: Further study is needed using greater numbers to clarify the re lationship between the surgical method and the presence of necrosis. To pre vent cutaneous necrosis, however, it may be preferable to use the cutdown m ethod in patients with the preexisting risk factors of arteriosclerosis obl iterans or in smokers.