Premium
The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel‐depleted neck
Author(s) -
Ciudad Pedro,
Agko Mouchammed,
Manrique Oscar J.,
Date Shivprasad,
Kiranantawat Kidakorn,
Chang Wei Ling,
Nicoli Fabio,
Lo Torto Federico,
Maruccia Michele,
Orfaniotis Georgios,
Chen HungChi
Publication year - 2017
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30193
Subject(s) - medicine , surgery , anastomosis , free flap , superior thyroid artery , thyroid
Background Reconstruction in a vessel‐depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel‐depleted neck. Methods Between July 2010 and June 2016, nine patients with a vessel‐depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release ( n = 3), oral ( n = 1), mandibular ( n = 3) and pharyngoesophageal ( n = 2) reconstruction necessitating free anterolateral thigh ( n = 3) and medial sural artery ( n = 1) perforator flaps, fibula ( n = 3) and ileocolon ( n = 2) flaps respectively. Results There was 100% flap survival rate with no re‐exploration or any partial flap loss. One case of intra‐operative arterial vasospasm at the anastomotic suture line was managed intra‐operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow‐up period. Conclusions In a vessel‐depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.