Summary
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 27, 2012
Accepted:
January 6,
2012
Received:
September 20,
2011
Footnotes
☆This work was presented at the 22nd Annual EURAPS meeting, June 2–4, 2011, Mykonos, Greece.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
