title: Use of a combined latissimus dorsi scapular free flap revascularized with vein grafting to the internal mammary artery in a vessel-depleted and previously irradiated neck.
abstract: BACKGROUND
  For patients who have extensive prior treatment, use of the internal mammary artery/vein (IMA/IMV) or cephalic vein has been shown to be a reliable option. Additionally, for those patients who require vascularized bone and extensive soft tissue reconstruction, the combined latissimus dorsi scapular free flap (mega-flap) is an excellent option.
  
  
  METHODS
  We reviewed 3 cases in which extensive prior surgery and radiation precluded the use of traditional recipient vessels in the neck.
  
  
  RESULTS
  Three patients with major jaw deformities were reconstructed using a mega-flap. In all cases, saphenous vein grafting succeeded in achieving arterial inflow from the IMA to the subscapular artery. Venous egress was achieved using a vein graft to the IMV in 1 patient and a transposed cephalic vein in the remaining 2 patients.
  
  
  CONCLUSIONS
  This approach of restoring large oral cavity defects for patients with extensive prior therapy and comorbid conditions has proven to be reliable and reproducible.
authors.affiliation: Albert Einstein College of Medicine, New York, New York; Thyroid Head and Neck Cancer Foundation, New York, New York.
authors.forename: William E
authors.initials: WE
authors.lastname: Karle
authors.forename: Sumeet M
authors.initials: SM
authors.lastname: Anand
authors.forename: Jason B
authors.initials: JB
authors.lastname: Clain
authors.forename: Sophie
authors.initials: S
authors.lastname: Scherl
authors.forename: Daniel
authors.initials: D
authors.lastname: Buchbinder
authors.forename: Mark L
authors.initials: ML
authors.lastname: Smith
authors.forename: Mark L
authors.initials: ML
authors.lastname: Urken
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery / Q000637:transplantation*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D064171:Superficial Back Muscles / Q000098:blood supply* / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery / Q000637:transplantation*; D014945:Wound Healing / Q000502:physiology