Microvascular anastomosis in pre-treated patients with head and neck carcinomas – a microsurgical challenge

Introduction Microvascularly pedicled flap reconstructions in the head and neck area are a suitable method for covering larger soft tissue defects and for maintaining function after tumor resections. The choice of the connecting vessel is a key task in the planning and surgical performance of the vascular anastomosis of the flap handle to the connecting vessel. But what about patients who have been preoperated on, preirradiated, and/or treated with a microvascular pedicled flap?

Methods The focus of this retrospective study is the benefit of all flap reconstructions with a microvascular anastomosis to the internal thoracic vessels (= internal mammary vessels), which is an alternative in scarred and irradiated head and neck tumor areas. As an advantage, the location outside the primary treatment area must be decisively emphasized. Possible disadvantages are not in all cases suitable dimensioned and fragile veins and the risk of pleural lesion and pneumothorax. Between 2015 and 2021, 12 patients were reconstructed with a free graft who had been pretreated. Radialis, ALT, or lattismus dorsi flaps were used. Subsequent complications are critical to the outcome of the transplanted flap.

Results A flap loss could not be observed. In half of the reconstructions, a complication-free course was shown. Fistulas occurred in 4 and dehiscences in 3 cases. Surgical flap revision had to be performed in 2 cases. All patients were satisfied with the reconstruction result.

Conclusion Vascular anastomosis to the internal thoracic vessels in pre-treated patients is a good alternative.

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Artikel online veröffentlicht:
24. Mai 2022