Free flap reconstruction of intra oral defects requires transfer of the vascular pedicle through subcutaneous or submandibular tunnels from the oral cavity to the neck in order to perform the microvascular anastomosis. Distortion and torsion can occur, as the pedicle is delivered through this tunnel. Various techniques have been described to reduce the incidence of such complications including a split open glove wrapped around the pedicle and insertion of a silk suture through the pedicle to facilitate its delivery.
We present our two-year experience with the sutureless suction slide technique. This involves utilisation of an endotracheal tube (ET) with the cuff removed or an appropriately sized chest drain. Following free flap harvest and isolation of the neck recipient vessels, an appropriate tunnel is created to transfer the vascular pedicle from the oral cavity to the neck. The ET tube is passed through the tunnel and the pedicle is carefully inserted into it. The suction tubing is attached to the distal end of the ET tube and saline inserted concurrently into the proximal end. Suction is applied in a periodic fashion to the distal end and the vascular pedicle is carefully delivered into the neck.
Results and discussion
The technique described is a simple, reproducible method that ensures safe and uncomplicated transfer of the vascular pedicle to facilitate microvascular anastomosis in head and neck reconstructions. Direct visualisation of the pedicle ensures the twisting, torsion and tension can be avoided.
The sutureless suction slide technique is a reliable method of preventing the common complications associated with transfer of the vascular pedicle from the oral cavity to the neck in microvascular head and neck reconstructions.