Management of donor and recipient veins in the vascularised autogenous submandibular gland transfer

Abstract

Objective: To discuss the management and selection of donor and recipient veins in the transfer of vascularised autogenous submandibular gland (SMG). Methods: The SMGs of 55 patients with severe keratoconjunctivitis were transferred to the temporal region by microsurgery. The secreted saliva was used as the substitute of tear. Donor and accepting-site vessels, vessels crisis and managements, survival of grafts were retrospectively analysed. Results: Transplantation succeeded in 55 patients (58 eyes) and failed in 2. For donor veins, 42 were facial veins, 14 were venae comitantes of facial artery, 2 were veins near the duct. For recipient veins, 44 were superficial temporary veins, 7 were deep temporary veins and 7 were veins in the upper neck. For recipient vein, except superficial temporary vein, deep temporary vein is also a good selection. After surgery, 2/5 venous crisis cases were rescued by re-anastomosed. Technetium-99 m examination suggested that the 56 SMGs were survived, and the ducts were unobstructed. Follow up lasted for 6 months to 10 years, the symptoms of photophobia and anemophobia were alleviated, the symptoms of corneal xerosis disappeared. Good clinical efficacy was obtained after transplantation. Conclusion: During SMGs transplantation, facial veins, venae comitantes of facial artery or vein near the duct can be used for donor vein. For recipient veins, except the superficial temporary veins as major, deep temporary veins or veins in the upper neck is also a section. Correct selection and microsurgical management of donor and recipient veins are keys to successful SMGs transplantation.