Staged Arteriovenous Loop for Recipient Vessels Preparing in a Difficult Case of Mandible Reconstruction

Background: Microvascular free tissue transfer has revolutionized the reconstruction of the head and neck after ablative surgery, with success rate over 95%. Suitable recipient vessels are, however, essential to ensure the survival of the flap and are often obtained from the carotid and jugular systems on the same side. In some conditions, arteriovenous loops work as indispensable tools when local vessels are not readily available. Aim and objectives: This case report aims to illustrate the role of two-stage arteriovenous loop in a difficult case of mandible reconstruction in the absence of suitable adjacent recipient vessels. Materials and methods: We used the great saphenous vein to create a temporary arteriovenous loop which was allowed to mature for one week and reconstructed a mandibular defect with free fibula osteocutaneous flap, with a restriction in the length of vascular pedicle. There was no suitable recipient vessels in the ipsilateral neck due to severe scarring after previous surgical intervention and irradiation for squamous cell carcinoma involving the left buccal mucosa. Results: Adequate blood flow in the long arteriovenous loop was confirmed during dividing the loop. The flap survived completely and the postoperative course was uneventful. Conclusion: Two-stage arteriovenous loop formation for recipient vessels preparing can be of great value in complex head and neck reconstruction. It is a reliable adjunctive technique which can provide healthy vessels to supply the free fibula flap.