Successful microsurgical free tissue transfer for head and neck reconstruction highly depends on the quality of the recipient vessels. In most cases, vessels near the site of resection are available; however, when the bilateral vascular network in the neck is compromised or inaccessible due to prior surgery and/or irradiation, alternatives have to be sought.
Secondary or tertiary head and neck reconstruction was performed using the internal mammary vessels (IMVs) as recipient vessels in seven patients who had undergone previous neck dissection and radiation therapy. Indications were: tracheal–oesophageal fistula or stenosis (n = 4), oesophageal–cutaneous fistula (n = 1), saliva fistula (n = 1) and oral cancer (n = 1). Free flaps used for reconstruction were radial forearm flap (FRFF) (n = 5), anterolateral thigh flap (ALT) (n = 3) and transverse rectus abdominis myocutaneous flap (TRAM) (n = 1). Within two patients an additional ALT flap was necessary for soft-tissue coverage and resurfacing of the neck. The IMVs were separately exposed in a standard fashion over the second or third rib. The pedicle of the flap was anastomosed anterograde and end-to-end to the recipient vessels in all cases. Mean pedicle length was 14.3 cm (11–20 cm), with a mean distance of 9.8 cm (7–13 cm) between the resection and recipient vessel site.
All patients were tumour free at time of re-operation and no sign of radiation injury was observed in the recipient vessels. All flaps survived and all patients healed without major complications. Mean follow-up time was 18 months. Four patients died of local recurrence or distant metastases during follow-up.
In the vessel-depleted neck, the IMVs are a reliable and easy accessible recipient area for microsurgical reconstruction of the head and neck. Surgical management and technique refinements for dissection of the vessels are discussed. In combination with free flaps with a long pedicle, especially perforator flaps, vein grafts are unnecessary and microsurgery can safely be performed outside the zone of injury.
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- Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck.N Eng J Med. 2004; 350: 1937-1944
- Selection of recipient vessels in double free flaps reconstruction of composite head and neck defects.Plast Reconstr Surg. 2005; 115: 1553-1561
- Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient.Plast Reconstr Surg. 1999; 103: 829-838
- Oromandibular reconstruction using a third free flap in sequence in recurrent carcinoma.Br J Plast Surg. 1999; 52: 429-433
- Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects.Microsurgery. 2007; 27: 588-594
- Geometry of the vascular pedicle in free tissue transfers to the head and neck.Arch Otolaryngol Head Neck Surg. 1989; 115: 954-960
- The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients.Plast Reconstr Surg. 2005; 115: 1253-1258
- The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck.Arch Otolaryngol Head Neck Surg. 2002; 128: 319-323
- Internal thoracic vessels as recipient vessels for free flap reconstruction in head and neck surgery.J Plast Reconstr Aesthet Surg. 2006; 59: 1348-1349
- Vessel-depleted neck: techniques for achieving microvascular reconstruction.Head Neck. 2008; 30: 201-207
- Use of the internal mammary vessels as recipient vessels for an omental flap in head and neck reconstruction.Ann Plast Surg. 2007; 58: 531-535
- Microvascular surgery in the previously operated and irradiated neck.Microsurgery. 2009; 29: 1-7
- Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck.Head Neck. 2006; 28: 797-801
- Second primary malignancies in patients with cancer of the head and neck.Otolaryngol Head Neck Surg. 2003; 129: 65-70
- Survival in second primary malignancies of patients with head and neck cancer.J Laryngol Otol. 2002; 116: 831-838
- Timing of radiotherapy in head and neck free flap reconstruction – A study of postoperative complications.JPRAS. 2009; 62: 889-895
- Recipient vessels in head and neck microsurgery: radiation effect and vessel access.Plast Reconstr Surg. 1993; 92: 628-632
- Pathogenesis of foam cell lesions in irradiated arteries.Am J Pathol. 1967; 50: 291-309
- The effect of preoperative radiotherapy on complication rate after microsurgical head and neck reconstruction.JPRAS. 2011 Jul 22;
- Algorithm in choosing recipient vessels for perforator free flap breast reconstruction: the role of the internal mammary perforators.Br J Plast Surg. 2004; 57: 258-265
- Interposition vein grafting in head and neck reconstructive microsurgery.J Reconstr Microsurg. 1993; 9: 245-251
Published online: January 27, 2012
Accepted: January 6, 2012
Received: September 20, 2011
☆This work was presented at the 22nd Annual EURAPS meeting, June 2–4, 2011, Mykonos, Greece.
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.