Download PDF
Facial Plast Surg 2020; 36(06): 746-752
DOI: 10.1055/s-0040-1721108
Original Article

Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck

Daniel C. Martinez
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Arvind Badhey
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Brian Cervenka
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Chad Zender
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Alice Tang
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Yash Patil
1   Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The vessel-depleted neck presents a unique and challenging scenario for reconstructive surgery of the head and neck. Prior surgery and radiation often result in significant scarring and damage to the neck vasculature, making identification of suitable recipient vessels for microvascular free tissue transfer exceedingly difficult. Therefore, alternative reconstructive techniques and/or vessel options must be considered to obtain a successful reconstructive outcome for a patient. In this article, we discuss our experience and approach to the management of the vessel-depleted neck, emphasizing the importance of preoperative planning and having multiple backup options prior to surgery. The various preoperative imaging modalities and available options for recipient arteries and veins are presented in detail. Additionally, we discuss modifications of select free flaps to maximize their utility in successful reconstruction. Together with thoughtful preoperative planning, these techniques can help aid the reconstructive surgeon in addressing the complex decisions associated with the vessel-depleted neck.

Keywords

vessel-depleted neck - salvage surgery - microvascular reconstruction - free tissue transfer - head and neck surgery


Publication History

Article published online:
24 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Shepherd KL, Fisher SE. Prospective evaluation of quality of life in patients with oral and oropharyngeal cancer: from diagnosis to three months post-treatment. Oral Oncol 2004; 40 (07) 751-757
    CrossrefPubMedGoogle Scholar
  • 2 le Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: analysis of 304 free flap reconstruction procedures. Laryngoscope 2012; 122 (05) 1014-1019
    CrossrefPubMedGoogle Scholar
  • 3 Eckardt A, Meyer A, Laas U, Hausamen JE. Reconstruction of defects in the head and neck with free flaps: 20 years experience. Br J Oral Maxillofac Surg 2007; 45 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 4 Hamoir M, Schmitz S, Suarez C. et al. The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers (Basel) 2018; 10 (08) 267
    CrossrefPubMedGoogle Scholar
  • 5 Mulholland S, Boyd JB, McCabe S. et al. Recipient vessels in head and neck microsurgery: radiation effect and vessel access. Plast Reconstr Surg 1993; 92 (04) 628-632
    CrossrefPubMedGoogle Scholar
  • 6 Schultze-Mosgau S, Erbe M, Keilholz L. et al. Histomorphometric analysis of irradiated recipient vessels and transplant vessels of free flaps in patients undergoing reconstruction after ablative surgery. Int J Oral Maxillofac Surg 2000; 29 (02) 112-118
    CrossrefPubMedGoogle Scholar
  • 7 Du E, Patel S, Huang B, Patel SN. Dual-phase CT angiography for presurgical planning in patients with vessel-depleted neck. Head Neck 2019; 41 (09) 2929-2936
    CrossrefPubMedGoogle Scholar
  • 8 Breik O, Praveen P, Parmar S. The vessel-depleted neck in head and neck microvascular reconstruction: extreme solutions for extreme situations. Curr Opin Otolaryngol Head Neck Surg 2020; 28 (02) 129-135
    CrossrefPubMedGoogle Scholar
  • 9 Kruse AL, Luebbers HT, Obwegeser JA, Bredell M, Grätz KW. Evaluation of the pectoralis major flap for reconstructive head and neck surgery. Head Neck Oncol 2011; 3: 12
    CrossrefPubMedGoogle Scholar
  • 10 Sugrue CM, Rooney G, Sugrue RM. Trapezius flaps for reconstruction of head and neck defects following oncological resection - a systematic review. J Craniomaxillofac Surg 2017; 45 (12) 2115-2119
    CrossrefPubMedGoogle Scholar
  • 11 Schneider DS, Wu V, Wax MK. Indications for pedicled pectoralis major flap in a free tissue transfer practice. Head Neck 2012; 34 (08) 1106-1110
    CrossrefPubMedGoogle Scholar
  • 12 Lee S, Cho HM, Kim JK, Nam W. The supraclavicular artery island flap: a salvage option for head and neck reconstruction. Maxillofac Plast Reconstr Surg 2018; 40 (01) 25
    CrossrefPubMedGoogle Scholar
  • 13 Su T, Pirgousis P, Fernandes R. Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks. J Oral Maxillofac Surg 2013; 71 (03) 622-627
    CrossrefPubMedGoogle Scholar
  • 14 Alain C, Fortier PH, Belzile M. The infraclavicular pedicled flap in head and neck reconstruction: applications and outcomes. Head Neck 2020; 42 (01) 77-84
    CrossrefPubMedGoogle Scholar
  • 15 Yoo J, Low TH, Tam S. et al. Pedicled adipofascial infraclavicular flap: Elevation technique and its use for maintaining neck contour and vessel coverage after radical and modified radical neck dissection. Head Neck 2016; 38 (10) 1579-1582
    CrossrefPubMedGoogle Scholar
  • 16 Andrews BT, McCulloch TM, Funk GF, Graham SM, Hoffman HT. Deltopectoral flap revisited in the microvascular era: a single-institution 10-year experience. Ann Otol Rhinol Laryngol 2006; 115 (01) 35-40
    CrossrefPubMedGoogle Scholar
  • 17 Mortensen M, Genden EM. Role of the island deltopectoral flap in contemporary head and neck reconstruction. Ann Otol Rhinol Laryngol 2006; 115 (05) 361-364
    CrossrefPubMedGoogle Scholar
  • 18 Roche NA, Houtmeyers P, Vermeersch HF, Stillaert FB, Blondeel PN. The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction. J Plast Reconstr Aesthet Surg 2012; 65 (07) 885-892
    CrossrefPubMedGoogle Scholar
  • 19 Hiller A, Davis J, Schulz S, Henderson J, Wilhelmi BJ. Recipient Vessel Selection in Head and Neck Reconstruction. Eplasty 2017; 17: e42
    PubMedGoogle Scholar
  • 20 Kim T, Chung S, Lanzino G. Carotid artery-hypoglossal nerve relationships in the neck: an anatomical work. Neurol Res 2009; 31 (09) 895-899
    CrossrefPubMedGoogle Scholar
  • 21 Avinçsal MÖ, Hiroshima Y, Shinomiya H, Shinomiya H, Otsuki N, Nibu KI. First bite syndrome - an 11-year experience. Auris Nasus Larynx 2017; 44 (03) 302-305
    CrossrefPubMedGoogle Scholar
  • 22 Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HF. Geometry of the vascular pedicle in free tissue transfers to the head and neck. Arch Otolaryngol Head Neck Surg 1989; 115 (08) 954-960
    CrossrefPubMedGoogle Scholar
  • 23 Weiglein AH, Moriggl B, Schalk C, Künzel KH, Müller U. Arteries in the posterior cervical triangle in man. Clin Anat 2005; 18 (08) 553-557
    CrossrefPubMedGoogle Scholar
  • 24 Tessler O, Gilardino MS, Bartow MJ. et al. Transverse cervical artery: consistent anatomical landmarks and clinical experience with its use as a recipient artery in complex head and neck reconstruction. Plast Reconstr Surg 2017; 139 (03) 745e-751e
    CrossrefPubMedGoogle Scholar
  • 25 Reiner A, Kasser R. Relative frequency of a subclavian vs. a transverse cervical origin for the dorsal scapular artery in humans. Anat Rec 1996; 244 (02) 265-268
    CrossrefPubMedGoogle Scholar
  • 26 Rosko AJ, Ryan JT, Wizauer EJ. et al. Dorsal scapular artery as a recipient vessel in the vessel-depleted neck during free tissue transfer in head and neck reconstruction. Head Neck 2017; 39 (07) E72-E76
    CrossrefPubMedGoogle Scholar
  • 27 Otsuka F, Yahagi K, Sakakura K, Virmani R. Why is the mammary artery so special and what protects it from atherosclerosis?. Ann Cardiothorac Surg 2013; 2 (04) 519-526
    PubMedGoogle Scholar
  • 28 Canham PB, Finlay HM, Boughner DR. Contrasting structure of the saphenous vein and internal mammary artery used as coronary bypass vessels. Cardiovasc Res 1997; 34 (03) 557-567
    CrossrefPubMedGoogle Scholar
  • 29 Jacobson AS, Smith M, Urken ML. Internal mammary artery and vein as recipient vessels in head and neck reconstruction. JAMA Otolaryngol Head Neck Surg 2013; 139 (06) 623-628
    CrossrefPubMedGoogle Scholar
  • 30 Cook JA, Tholpady SS, Momeni A, Chu MW. Predictors of internal mammary vessel diameter: a computed tomographic angiography-assisted anatomic analysis. J Plast Reconstr Aesthet Surg 2016; 69 (10) 1340-1348
    CrossrefPubMedGoogle Scholar
  • 31 Harris JR, Lueg E, Genden E, Urken ML. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg 2002; 128 (03) 319-323
    CrossrefPubMedGoogle Scholar
  • 32 Bechmann S, Rahman S, Kashyap V. Anatomy, head and neck, external jugular veins. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020
    Google Scholar
  • 33 Horng SY, Chen MT. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction. Plast Reconstr Surg 1993; 92 (04) 752-753
    CrossrefPubMedGoogle Scholar
  • 34 Gundeslioglu AO, Selimoglu N, Toy H, Koç O. Neo-vascularisation of musculocutaneous and muscle flaps after division of the major vascular supply: an experimental study. J Plast Reconstr Aesthet Surg 2013; 66 (07) 978-986
    CrossrefPubMedGoogle Scholar
  • 35 Moolenburgh SE, van Huizum MA, Hofer SO. DIEP-flap failure after pedicle division three years following transfer. Br J Plast Surg 2005; 58 (07) 1000-1003
    CrossrefPubMedGoogle Scholar
  • 36 Yoon AP, Jones NF. Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: a review of the literature. Microsurgery 2016; 36 (07) 604-612
    CrossrefPubMedGoogle Scholar
  • 37 Wells MD, Luce EA, Edwards AL, Vasconez HC, Sadove RC, Bouzaglou S. Sequentially linked free flaps in head and neck reconstruction. Clin Plast Surg 1994; 21 (01) 59-67
    CrossrefPubMedGoogle Scholar
  • 38 Ceulemans P, Hofer SO. Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction. Br J Plast Surg 2004; 57 (04) 358-361
    CrossrefPubMedGoogle Scholar
  • 39 Trinh BB, French B, Khechoyan DY, Deleyiannis FW. Designing a fibular flow-through flap with a proximal peroneal perforator-free flap for maxillary reconstruction. Plast Reconstr Surg Glob Open 2017; 5 (11) e1543
    CrossrefPubMedGoogle Scholar
  • 40 Bullocks J, Naik B, Lee E, Hollier Jr L. Flow-through flaps: a review of current knowledge and a novel classification system. Microsurgery 2006; 26 (06) 439-449
    CrossrefPubMedGoogle Scholar
  • 41 Furr MC, Cannady S, Wax MK. Interposition vein grafts in microvascular head and neck reconstruction. Laryngoscope 2011; 121 (04) 707-711
    CrossrefPubMedGoogle Scholar
  • 42 Moubayed SP, Giot JP, Odobescu A, Guertin L, Harris PG, Danino MA. Arteriovenous fistulas for microvascular head and neck reconstruction. Plast Surg (Oakv) 2015; 23 (03) 167-170
    CrossrefPubMedGoogle Scholar
  • 43 Cha YH, Nam W, Cha IH, Kim HJ. Revisiting radial forearm free flap for successful venous drainage. Maxillofac Plast Reconstr Surg 2017; 39 (01) 14
    CrossrefPubMedGoogle Scholar
  • 44 Ferrari S, Ferri A, Bianchi B. Scapular tip free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (02) 115-120
    CrossrefPubMedGoogle Scholar
  • 45 Seneviratne S, Duong C, Taylor GI. The angular branch of the thoracodorsal artery and its blood supply to the inferior angle of the scapula: an anatomical study. Plast Reconstr Surg 1999; 104 (01) 85-88
    CrossrefPubMedGoogle Scholar