title: Arterial microanastomoses on the reverse flow of the internal carotid artery reverse flow: an extreme solution in free-flap revascularisation. How we do it.
abstract: Microvascular free tissue transfer in head and neck reconstruction requires suitable recipient vessels, which are frequently compromised by prior surgery, radiotherapy, or size of the tumour. A surgical description of an arterial free flap pedicle anastomosis on the reverse internal carotid arterial flow in a vessel-depleted neck is presented. A 66-year-old male with a relapse of hypopharyngeal squamous cell carcinoma previously treated with both surgical and radiation therapy for carcinoma of the tongue and the larynx was successfully reconstructed using a free forearm flap with reverse internal carotid arterial flow. The involvement of the carotid glomus and prior surgery excluded the other vessels as recipients. The forearm free flap survived without any complications. This procedure can be considered an alternative rescue technique for salvage reconstruction in a vessel-depleted neck.
authors.affiliation: Department of Maxillofacial Surgery, Department of Specialistic Surgical Sciences, "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", Università di Milano;
authors.forename: A
authors.initials: A
authors.lastname: Baj
authors.affiliation: Department of Maxillofacial Surgery, Department of Specialistic Surgical Sciences, "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", Università di Milano;
authors.forename: A
authors.initials: A
authors.lastname: Bolzoni
authors.affiliation: Department of ENT, Department of Specialistic Surgical Sciences "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", Università di Milano.
authors.forename: S
authors.initials: S
authors.lastname: Torretta
authors.affiliation: Department of ENT, Department of Specialistic Surgical Sciences "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", Università di Milano.
authors.forename: L
authors.initials: L
authors.lastname: Pignataro
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D005542:Forearm; D058752:Free Tissue Flaps; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000637:transplantation*; D012039:Regional Blood Flow; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Carotid artery; Free-flap; Head and neck cancer; Microanastomoses; Reverse flow