Vessel-depleted neck: techniques for achieving microvascular reconstruction.
BACKGROUND
In the neck, the recipient vessels most frequently used for microsurgical reconstruction are compromised by prior surgery and radiation.


METHODS
We conducted a retrospective chart review of all patients who underwent microvascular reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined.


RESULTS
Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap.


CONCLUSIONS
The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck.
Jacobson
Adam S
AS
Mount Sinai School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Head and Neck Cancer Center, Mount Sinai Medical Center, New York, New York, USA.
Eloy
Jean Anderson
JA
Park
Eunice
E
Roman
Benjamin
B
Genden
Eric M
EM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D037981:Neck Dissection; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*