title: Use of internal mammary vessels in head and neck microvascular reconstruction.
abstract: OBJECTIVE
  To describe the use of the internal mammary vessels (IMVs) in microvascular head and neck reconstruction in a small case series with select donor sites.
  
  
  METHODS
  Retrospective medical record review study.
  
  
  METHODS
  Oregon Health and Science University and University of Alabama.
  
  
  METHODS
  Patients for whom IMVs were used for head and neck reconstruction from January 1, 1998, through December 31, 2010.
  
  
  METHODS
  Intraoperative or postoperative complications, flap survival, and morbidity due to the flap.
  
  
  RESULTS
  Of 2721 free tissue transfers, 55 (2%) (in 48 patients) used IMVs. Use of IMVs was associated with ablative surgery with sternal resection (25 of 55 [45%]), a vessel depleted neck (23 of 55 [42%]), and fistula repair with gross contamination due to prior flap failure or chronic pharyngocutaneous fistula with vessel depleted neck (7 of 55 [13%]). Flaps included radial forearm (33 of 55 [60%]), jejunum (9 of 55 [16]), ulnar (5 of 55 [9%]), and other (8 of 55 [14%]). No vein grafts were used. Pneumothorax developed in 1 patient (2%). Postoperative fistulas were observed in 14 of 48 patients (29%); the fistulas healed conservatively in 7 patients (50%), rotation of flap tissue was required in 2 patients (14%), and the fistulas persisted in 5 patients (36%). The flap survival rate was 98%.
  
  
  CONCLUSIONS
  Internal mammary vessels provide reliable recipient vessels for cervical and sternal microvascular reconstruction.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Schneider
authors.forename: Lauren
authors.initials: L
authors.lastname: McClain
authors.forename: Philip K
authors.initials: PK
authors.lastname: Robb
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome