title: Microvascular reconstruction in the vessel-depleted neck.
abstract: OBJECTIVE
  Microvascular reconstruction for head and neck cancers has improved both cosmesis and functionality of patients undergoing treatment. Many patients have had prior surgery (neck dissection), radiation and/or chemotherapy as part of their management. When microvascular reconstruction is required after previous treatment, finding appropriate vessels for anastomosis can be difficult. In this paper we explore the options for microvascular reconstruction in the vessel-depleted neck.
  
  
  RESULTS
  Arterial options that exist when the neck is depleted of vessels include the superficial temporal, transverse cervical, thoracoacromial, and the internal mammary artery. Venous options include the cephalic vein and vein grafts.
  
  
  CONCLUSIONS
  The external carotid artery and the internal jugular vein are the most commonly utilized vessels in microvascular reconstruction when available. However, prior chemotherapy and/or radiation can cause significant scarring and damage to these vessels. Also in patients who have had previous surgery, these vessels can be resected or altered in a way that they are deemed unusable. In these situations several vascular options exist outside the neck.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Wong
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Higgins
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Enepekides
mesh_terms: D000714:Anastomosis, Surgical; D001158:Arteries / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D009333:Neck / Q000098:blood supply*; D013524:Surgical Flaps / Q000098:blood supply*; D014680:Veins / Q000637:transplantation*