Reverse flow as an option in microvascular recipient anastomoses

This study was designed to investigate the retrograde arterial pressures in the distal ends of the superior thyroid (n = 20) and facial arteries (n = 8). These pressures were compared with mean systemic arterial pressure (n = 20) as well as retrograde pressure in the radial artery (n = 8). The mean retrograde arterial pressure in the radial artery was 50 to 60 percent of normal arterial pressure. Similar pressures were recorded from the distal ends of both the superior thyroid and facial arteries. Because we know that the radial artery can support a skin flap through retrograde or reverse flow (reverse radial forearm flap), it was concluded that both the superior thyroid and facial arteries could also support flaps based on reverse flow. This has proved to be the case clinically. In circumstances where pedicle geometry favors it and in the presence of pulsatile flow from the distal ends of either of these arteries, a retrograde anastomosis is now the practice of the authors in selected cases.