1. 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

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

3. 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.

4. 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

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

6. 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

7. 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

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

9. 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)

10. M48，Gingival SCC，radical ND / radiation

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

15. ALLEN’S Test

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

18. Thanks