LETTER TO THE EDITOR Use of Spongostan™ for pedicle stabilisation in head and neck microvascular reconstruction Sunil Choudhary 1 & Raghav Mantri 1 & Prateek Arora 1 Received: 14 January 2015 /Accepted: 7 April 2015 /Published online: 28 April 2015 # Springer-Verlag Berlin Heidelberg 2015 Sir, Microvascular pedicle is of utmost importance in head and neck reconstruction as kinking and unfavourable geometry of the pedicle can cause thrombosis leading to the disastrous complication of free flap failure. Head and neck areas are particularly prone due to the need to use long pedicle to reach neck donor vessels and also the possibility of neck movements causing inadvertent kinking due to pedicle dislodgement. Various techniques and materials have been described in the literature for microvascular pedicle stabilisation, but all have some disadvantages. Tacking sutures [1] are commonly used but are not flexible and can cause vessel wall pull or constriction. Fibrin glue [2] can seep into the vessel lumen at the anastomotic site and actually cause thrombosis. Autologous fat [3] can be a good pedicle stabiliser, but large amounts will undergo necrosis and can increase the poten- tial for wound infection. Recently, polyglycolic acid nerve conduit [4] has been described for this purpose, but it has the disadvantage of being inflexible and expensive. Polydioxanone suture fixed to the adventitia to prevent kinking have also been described but again suffers from being inflexible and hence incapable of imparting a desirable curve to the pedicle [5]. We have been using commonly available hemostatic gela- tin sponge (Spongostan™, Ethicon, Somerville, USA) as a microvascular pedicle stabiliser for most of our head and neck reconstructions. Small 1- to 2-cm postage stamp style Spongostan pieces are cut out and used either as single or in stacks to support the microvascular pedicle. These are used in different configurations like ‘side rails’ along the length, stacks as foundation underneath the pedicle to obliterate dead space or ‘push inserts’ to change the acute curvature of the pedicle to attain a geometrically favourable lie of the pedicle (Figs. 1 and 2). As Spongostan™ is hemostatic, it sticks to the raw surfaces of the pedicle and base. The Spongostan™ has many advan- tages in this role as it is available off the shelf in every oper- ating room, already has a great safety record as a hemostatic agent, is biodegradable, cost effective, does not migrate and incites minimal or no local foreign body reaction. It also seems to protect the pedicle from inadvertent dislodgement due to suction drains. Fig. 1 Microvascular arterial anastomosis in a free flap oral malignancy reconstruction showing acute curve and lack of support for the long pedicle * Sunil Choudhary plasticsurgerymax@gmail.com 1 Institute of Aesthetic & Reconstructive Plastic Surgery, Max Superspeciality Hospital, 1-2 Press Enclave Road Saket, New Delhi 110017, India Eur J Plast Surg (2015) 38:425–426 DOI 10.1007/s00238-015-1091-4