Pre-operative consideration and Selection of Microsurgical Vessels 徐 立 群 Liqun Xu（MD,DDS) Dept. of Oral & Maxillofacial – Head & Neck Oncology Shanghai Ninth People’s Hospital, Shanghai (200011) China

Common Choice of Artery of Recipient Site External Carotid Superficial Temporal Facial… Tongue Sup.thyroid Thyrocervical trunk Transverse cervical Inferior thyroid Sup.scapular

Choice of Vein Superficial temporal External jugular Branches of internal jugular (common facial) Thyroid Transverse cervical And for the vein usually we used the branches of internal jugular vein or sometimes we used external jugular vein for anastomosis.

Advanced Carcinoma of Mouth Floor with Cervical Lymph Nodes Metastases Here showed us a rare case with combination of three flaps to repair the huge defect in lower face and neck. Lesions in floor of mouth, mental and cervical region

Incision design Composite defects after oncological ablation Incision designed, and raw surface of defects. Composite defects after oncological ablation Incision design

① ② ③ Latissimus dorsi myocutaneous flap Fibular flap A total of three flaps was applied for this patient. ① Pectoralis major myocutaneous flap Latissimus dorsi myocutaneous flap Fibular flap

Raw surface during surgery with three different free flaps Latissimus Dorsi Flap Fibula Flap Pectoralis Major Flap Raw surface during surgery with three different free flaps

Postoperative Appearance (2 years later) This patient survived 2 years.

Difficult (recurrence/radiated) Cases Choice of Vessels in Difficult (recurrence/radiated) Cases Order Transverse cervical Contralateral vessel Pedicle of last flap Cephalic vein (upper arm) Internal thoracic artery Long vascular pedicle (pedicled LDMF)

M48，Gingival SCC，radical ND / radiation

Pre-operative consideration -- local condition Donor site examination Receipt site examination

ALLEN’S Test

Pre-operative Health ——influences final results Systemic disease (diabetes) Peripheral vascular disease Malnutrition Smoking Obesity

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