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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
Author(s) -
Karle William E.,
Anand Sumeet M.,
Clain Jason B.,
Scherl Sophie,
Buchbinder Daniel,
Smith Mark L.,
Urken Mark L.
Publication year - 2013
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/hed.23194
Subject(s) - medicine , cephalic vein , surgery , vein , free flap , artery , mammary artery , latissimus dorsi muscle , radiation therapy , soft tissue
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. © Wiley Periodicals Inc. Head Neck , 35 : E328–E332, 2013