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Superficial temporal and occipital arteries in free flap scalp reconstruction: anatomical and radiologic study

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Abstract

Background

The reconstruction of scalp defects represents a major challenge due to the need for functional and cosmetic coverage. Free flaps are often the preferred approach for managing significant scalp defects, but proper recipient vessel selection is crucial for successful tissue transfer. The scalp is highly vascularised and offers multiple options. Occipital vessels are valuable for anastomosis and less frequently used.

Methods

Superficial temporal and occipital arteries were studied and compared using angio-computed tomography (Angio-CT) scans and ultra-sound Doppler (US-Doppler). Additional exploration was performed with cadaveric dissections. A total of 30 subjects were examined using Angio-CT scan and 32 using US-Doppler, and 11 hemi-faces were dissected.

Results

Respectively, superficial temporal arteries and occipital arteries have a mean diameter of 1.8 mm and 1.5 mm in cadaveric dissections, 1.69 mm and 1.51 mm in Angio-CT scans and 1.38 mm and 1.54 mm in US-Doppler.

Conclusions

Occipital arteries are stable and reliable alternatives for free flap reconstruction of the scalp. Based on these anatomical and radiologic findings, the occipital artery, in its sub-cutaneous segment, can be used as a recipient vessel in scalp reconstruction, in case of flap with a short pedicle, vertex or parieto-occipital defects and especially in complex cases with missing external carotid system.

Level of evidence: Level IV, diagnostic study

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Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Funding

The authors declare that they have no funding.

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Authors and Affiliations

  1. Plastic, Reconstructive and Aesthetic Surgery Unit, Centre François Xavier Michelet, Bordeaux University Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France

    Bassel Hoteit, Vincent Casoli & Anais Delgove

  2. Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy

    Evelina Caprarella

  3. Oncologic and Reconstructive Surgery Unit, Bergonié Institute, 168 Cours de L’Argonne, 33000, Bordeaux, France

    Audrey Michot

Authors
  1. Bassel Hoteit
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  2. Evelina Caprarella
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  3. Vincent Casoli
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  4. Anais Delgove
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  5. Audrey Michot
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Corresponding author

Correspondence to Bassel Hoteit.

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Ethical approval

Ethical approval was granted by the local hospital committee. This study adhered to the ethical standards as per the institutional review board. The specimens were obtained from a university-affiliated body donation program from the Faculty of Medicine at the University of Bordeaux (France) in accordance with the legal procedures and ethical framework governing body donation in France.

Consent to participate

Verbal authorization was obtained from each volunteer performing US-Doppler. Data from CT angiography group patients were properly anonymized to avoid identification.

Conflict of interest

Bassel Hoteit, Evelina Caprarella, Vincent Casoli, Anais Delgove and Audrey Michot declare no competing interests.

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Hoteit, B., Caprarella, E., Casoli, V. et al. Superficial temporal and occipital arteries in free flap scalp reconstruction: anatomical and radiologic study. Eur J Plast Surg 47, 31 (2024). https://doi.org/10.1007/s00238-024-02168-3

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  • DOI: https://doi.org/10.1007/s00238-024-02168-3

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