Comprehensive Analysis on the Use of Superficial Temporal Vessels as Free Flap Recipients in Head and Neck Reconstruction: Systematic Review on Anatomic Characteristics and Surgical Outcomes

Abstract

Background

Head and neck reconstruction often involves complex defects requiring microvascular free flaps. While cervical vessels are commonly used as recipients, anatomical variations and prior interventions may necessitate alternative options. The superficial temporal vessels (STV) offer advantages such as accessibility, suitable caliber, and proximity to craniofacial defects. This study systematically evaluates the anatomical and surgical outcomes of STV in head and neck reconstruction.

Methods

A systematic review following PRISMA guidelines was conducted across PubMed and Scopus to identify studies on the anatomical characteristics and surgical outcomes of STV. Inclusion criteria focused on studies involving adult patients, reporting surgical outcomes with STV as recipient vessels, and presenting anatomical measurements. Statistical analysis of flap survival, complications, and vessel caliber was performed using IBM SPSS 30.0.

Results

Twenty-two studies on surgical outcomes (506 flaps) and 23 anatomical studies (976 specimens) were analyzed. STV exhibited a mean arterial caliber of 2.30 mm at the origin, 1.88 mm at the zygomatic arch, and 1.51 mm at the bifurcation, with vein diameters averaging 2.58 mm. The flap survival rate was 96.72%, with major complications in 15.4% of cases and anastomosis revision in 5.14%. The anterolateral thigh flap was the most common donor site (177 cases). STV use was most frequent in middle-third facial defects (33%).

Conclusion

The STV are reliable alternatives for microvascular reconstruction in head and neck surgery, particularly for defects in the upper and middle thirds of the face. Their favorable anatomical characteristics and high flap survival rates underscore their potential as primary or secondary recipient vessels, especially in vessel-depleted necks.