Determining length and position of pedicle vessels using a flap model with vascular tape

In free-flap surgery, if the appropriate length of the pedicle and the distance necessary for separation of the artery and vein are determined earlier during flap elevation, the operative time and the stress placed on the flap pedicle can be reduced. However, the pedicle of a flap passes through 3-dimensional structures, particularly in head and neck reconstructions, and because of the difference in body shapes between individuals, even experienced microsurgeons may misjudge the required distance. To date, no easy method to counteract this problem has been reported. Accordingly, we have developed a technique for estimating the required pedicle length necessary for safe vascular anastomosis, as well as the distance necessary for separation of the artery and vein, by using a flap model with vascular tapes. Between June 2014 and April 2016, we applied our technique to 12 patients undergoing head and neck reconstruction and 1 patient undergoing breast reconstruction. In the 13 cases in which the present technique was used, we could estimate the length of each pedicle smoothly and efficiently. Furthermore, considerable excess or deficiency did not occur in the vascular anastomosis. The present technique is recommended as it allows the effective tailoring of the flap pedicle in free-flap surgery.