title: Internal Mammary Vessels: Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction.
abstract: The application of microvascular free tissue transfer for reconstruction of the head and neck is well established. Improved outcomes, as well as surgical and technologic advances, have broadened the applications of microvascular free flaps in these defects. Postoperative complications such as pharyngocutaneous fistulas, tracheal or esophageal stenoses, or recurrent pathology may occasionally require secondary or even tertiary reconstruction with free tissue transfers. The disrupted anatomy and fibrotic changes resulting from primary reconstruction, neck dissection, and irradiation present the surgeon with a high risk of provoking vascular or nervous injury when dissecting in previously operated or irradiated sites. This prompts a search for alternative recipient vessels for microvascular anastomosis. The transverse cervical, inferior thyroid, and thyrocervical trunk arteries have all been proposed as alternative recipient vessels. The internal mammary vessels (IMVs) have a proven record in breast reconstruction, but recently have been found to have an application in special circumstances in head and neck reconstruction. This investigation describes the advantages of the IMVs as suitable recipient vessels for head and neck reconstruction when access to traditional vasculature is unavailable.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Buck
authors.affiliation: Professor, Department of Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR. Electronic address: petrisor@ohsu.edu.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Petrisor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D037981:Neck Dissection; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome