Carotid artery and soft tissue reconstruction with superficial femoral artery‐sartorius muscle‐anteromedial thigh chimeric free flap: A case report and review of the literature

Abstract

Tumoral involvement of the carotid artery may require en-bloc resection in order to achieve a better regional control. Among the carotid reconstruction methods at disposal, autologous tissues appear to be more reliable in cases with high risk of infection and poor tissue healing like in radiated necks. We describe a case of a 55 year old man, who suffered from recurrent squamous cell carcinoma in the neck region, invading the common carotid artery. After en-bloc resection of the tumor together with skin, internal jugular vein, vagus nerve and common carotid artery, carotid reconstruction was performed with a flow-through chimeric flap based on superficial femoral vessels (15 cm). After resection of the tumor, the flap was used to replace the soft tissue defect (23 Â 12 cm). Anteromedial thigh skin paddle (8 Â 5 cm) and sartorius muscle (12 Â 3 cm) were included in the flap. The superficial femoral vessels were reconstructed with 8-mm ringed polytetrafluoroethylene graft interposition.Thanks to an accurate surgical planning and a 2-team approach, the ischemia time of the leg was 42 min and there were no limb ischemia nor pathologic neurological signs after surgery. During the 12-month follow up, no other complication was registered.In our experience, microsurgical carotid reconstruction represents a reliable option with important advantages such as resistance to infection, optimal size matching, and good tissue healing between the irradiated carotid stump and the vascular graft. | INTRODUCTIONTumor involvement of the carotid artery continues to post great challenges for head and neck surgeons. En-bloc resection allows for better regional control of the disease, with an increase of the five-year disease-free survival rate in the locally advanced tumor, and a decrease of the incidence of potentially fatal neck complications (Pons et al., 2009).Several methods are available for carotid artery reconstruction (He et al., 2011;Zheng et al., 2009). Among those methods, carotid artery reconstruction with autologous tissue seems to be an ideal option in cases with high risk of infection and poor tissue healing such as following radiation (Pons et al., 2009). In medical literature, there are few reports about composite tissue reconstruction using femoral vessels as a flow-through chimeric flap (Leduey et al., 2013).The aim of this report is to present our original case of carotid reconstruction with a flow-through chimeric flap composed of femoral vessels with sartorius muscle and anteromedial thigh. In addition, we carried out a literature review of autologous carotid reconstruction techniques applied in cases of tumoral involvement and resection of