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Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction
Author(s) -
Brown Dale H.,
Mulholland Steve,
Yoo John H. J.,
Gullane Patrick J.,
Irish Jonathan C.,
Neligan Peter,
Keller Anne
Publication year - 1998
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/(sici)1097-0347(199803)20:2<169::aid-hed11>3.0.co;2-h
Subject(s) - medicine , internal jugular vein , surgery , neck dissection , jugular vein , thrombosis , venous thrombosis , dissection (medical) , radiology , head and neck cancer , radiation therapy , carcinoma
Background The incidence of internal jugular vein thrombosis (IJVT) following a modified neck dissection remains uncertain. The effect of, or consequences following, IJVT upon pedicled and free flap head and neck reconstructions remains unexplored. Methods Twenty‐nine preserved internal jugular veins in 24 patients undergoing modified neck dissection were available for prospective study. All patients required a pedicled or free flap reconstruction and received a modified, unilateral or bilateral cervical lymphadenectomy. The patency of all jugular veins was determined preoperatively and postoperatively using a combination of computed tomography (CT) scanning, high‐resolution ultrasound, and color‐flow Doppler (CFD). Results The IJVT rate was 14%. The presence of a pedicled myocutaneous flap and left‐sided jugular dissections may represent risks to the postoperative patency of the internal jugular vein. Preoperative radiotherapy did not appear to impact negatively upon the thrombosis rate. Conclusions Thrombosis of the internal jugular vein may result in significant morbidity for the postoperative oncologic patient. An internal jugular‐dependent‐free‐tissue transfer may risk venous compromise of the flap, whereas the use of a pedicled flap may place the jugular at increased risk for thrombosis. Strategies for deep venous system microvascular recipient recruitment in the head and neck are discussed. Wherever possible, we employ two deep venous systems, the internal jugular, and subclavian (via the external jugular) for flap drainage. © 1998 John Wiley & Sons, Inc. Head Neck 20: 169–174, 1998.