Superficial Temporal Vessels Show Feasibility in Maxillofacial Reconstruction, Study Finds
A single-center study evaluating the use of superficial temporal vessels as recipient sites for microvascular reconstruction in 20 patients found a 94.4% flap survival rate, with challenges primarily linked to venous caliber variability. The research, conducted between January 2019 and December 2025, highlights the potential of these vessels in complex head and neck reconstructions.
Superficial Temporal Artery Flaps Show 89.5% Survival Rate
The study included 20 patients undergoing maxillofacial reconstruction, with 18 cases utilizing the superficial temporal artery and 17 using the vein for drainage. Flap survival rate was 94.4% (17/18), though two patients required intraoperative conversion due to inadequate venous caliber. One conversion led to total flap loss, while the other used a pedicled flap. Overall, 17 of 19 free flaps survived, resulting in an 89.5% survival rate across all cases.
The study noted that venous caliber variability remained a critical factor, with two conversions necessitated by insufficient drainage capacity.
Inadequate Venous Caliber Necessitates Intraoperative Conversions
Surgeons faced difficulties in assessing venous suitability, particularly in cases where the superficial temporal vein’s diameter or flow was inadequate. In such scenarios, further dissection into the temporal region was required to locate alternative venous branches. When this proved unsuccessful, conversions to cervical vessels or pedicled flaps were performed. The decision to convert was based on intraoperative evaluation of anastomotic risks, with indocyanine green angiography used to confirm flap perfusion.
“Inadequate venous caliber remains an important cause of intraoperative conversion,” the study concluded, emphasizing the need for meticulous preoperative and intraoperative assessment of vessel dimensions.
Comparative Advantages Over Cervical Vessels
The superficial temporal vessels offer advantages in cases where cervical access is limited, such as in previously treated or irradiated regions. Their proximity to midfacial and cranial defects reduces pedicle length, minimizes tunneling, and allows for direct, tension-free anastomosis. Avoiding cervical dissection reduces morbidity and preserves neck vessels for future procedures.
Future Research Directions
The study’s authors called for larger, prospective multicenter trials to standardize vessel assessment protocols and clarify the role of superficial temporal vessels in reconstructive surgery. Current limitations include the small sample size, retrospective design, and single-surgeon experience, which restrict the generalizability of findings.
“Larger, preferably multicenter comparative studies are needed to better define the indications, contraindications, and long-term performance of the superficial temporal system,” the conclusion stated.
What Was the Flap Survival Rate?
What was the flap survival rate using superficial temporal vessels?
The study reported a 94.4% flap survival rate (17/18) for cases utilizing the superficial temporal artery, with an overall survival rate of 89.5% (17/19) across all free flaps.
Why were intraoperative conversions necessary?
Two conversions occurred due to inadequate venous caliber, with one case requiring a switch to cervical vessels and another to a pedicled flap. The study attributed these decisions to the risk of venous congestion or arterial insufficiency during surgery.
What future research is recommended?
The study emphasizes the need for prospective, multicenter analyses with larger cohorts and standardized outcome measures to evaluate the long-term efficacy and broader applicability of superficial temporal vessels in reconstruction.
Worth a look