Free tissue transfer as a vascular source for the vessel‐depleted neck

Tsao, Chung‐Kan; Loh, Charles Yuen Yung; Barrera, Joaquim Megias

doi:10.1002/hed.24539

Cited by 12 publications

(4 citation statements)

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“…However, certain considerations such as size and volume, donor site morbidity, ease of harvest and a strategized use of flaps where defects are sized appropriately to the amount of tissue provided by a particular flap. [ 15 ] In patients with subtotal glossectomy defects, the use of the MSAP flap provides comparable volume replacement with pliability and suppleness required for adequate tongue mobility without obliterating the oral cavity. ( Fig 2 ) The donor site of the MSAP flap at the lower extremity of the patient allows for adequate space between the team performing the oncological resection and the reconstructive surgeon.…”

Section: Discussionmentioning

confidence: 99%

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

et al. 2017

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IntroductionOncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use.Materials and methodsFrom December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted.ResultsA 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding.ConclusionThe MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake.

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Section: Discussionmentioning

confidence: 99%

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

et al. 2017

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“…[ 14 ] Microvascular reconstruction in the head and neck is more challenging in patients who have undergone previous neck dissection due to prior resection of potential recipient blood vessels. [ 15 16 ] It is understood that a relative unavailability of potential recipient blood vessels in the neck might result in an increased risk of free flap failure in patients with a history of previous neck dissection. [ 6 17 ]…”

Section: Discussionmentioning

confidence: 99%

“…This makes availability of a recipient vein within the field of previous modified radical or radical neck dissection more difficult compared with after previous selective neck dissection where the external or IJVs are more commonly preserved. [ 12 15 17 ]…”

Section: Discussionmentioning

confidence: 99%

Feasibility and reliability of microvascular reconstruction in the vessel-depleted previously operated neck

Reddy

Sham²,

Ganesh

et al. 2020

Ann Maxillofac Surg

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Background: Microvascular reconstruction of defects in the head and neck has always been a challenge in patients who have undergone previous neck dissection, owing to the prior resection of potential recipient blood vessels used for free flap perfusion. Objective: The objective of the study is to evaluate the reliability and safety of free flap reconstruction in patients who have had previous neck dissection. Materials and Methods: Twenty-four free flaps were performed in 22 patients with a previous history of neck dissection for head-and-neck squamous cell carcinoma. These included patients who underwent salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction following previous oncological resections. Flap includes 12 radial forearm free flaps, 5 fibula flaps, 1 rectus abdominis flap, and 6 anterolateral thigh flaps. Results: In cases with the previous history of selective neck dissection, recipient vessels on the ipsilateral/same side of the previously operated neck were used, while contralateral vessels were used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary, except for one case. In our series, we did not have any flap loss or considerable increase in operative time. Conclusions: Free flap reconstruction of head-and-neck defects is highly successful in patients with a history of previous neck dissection, despite a relative scarcity of recipient blood vessels. Careful planning and relying on flaps with a long vascular pedicle obviates the need to perform a suitable vein graft. In our present series, careful planning and the right choice of a free flap with a long vascular pedicle contributes to the absence of free flap failure. In our experience, previous neck dissection should not be considered as a contraindication to microvascular reconstruction of previously operated oncologic defects.

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“…Vessel-depleted neck is a term commonly used in literature. There is no universally accepted definition for vessel-depleted neck; however, it is being loosely used with free tissue transfers in difficult situations after tumor ablation [3]. Some people consider vessel-depleted neck as a situation where the internal jugular vein and multiple branches of external carotid artery are either resected or are not suitable to be used as a recipient vessel for reconstruction and hence the vessels outside the neck should be looked into [4].…”

Section: Discussionmentioning

confidence: 99%

Microvascular Free Tissue Transfer in Vessel-Compromised Neck: Techniques and Recommendations

Mahendru¹,

Singh²,

Sarin³

et al. 2019

IMJ

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Objective: Vessel-depleted neck is a challenge for the microvascular surgeon planning for a free tissue transfer. We consider vessel-compromised neck as a situation where a patient has undergone previous neck dissection along with postoperative radiotherapy and has planned for free tissue transfer on the same side for second primary/recurrence. This study describes our experience of successful free tissue transfer in the vessel-compromised neck and the techniques adopted for the same. We also propose an algorithm for vessel-compromised neck. Methods: All patients who required a free flap in the head and neck region after previous neck dissection and radiation in the last 4 years were included in this study. These patients had either recurrence or second primary requiring re-resection and free flap reconstruction. Technical operative data including the availability of recipient vessels, the need to access the contralateral side of the neck, and anastomosis sites were logged in the database. Results: Of the 359 free flaps, 38 patients were classified as having vessel-compromised neck. During the first surgery, 19 out of 38 patients underwent reconstruction in the form of free flap, 15 had wide local excision (primary closure) and neck dissection, while 4 patients underwent reconstruction with local flaps. In the second surgery, the recipient vessels were chosen on the ipsilateral side in 22 patients and contralateral in 16 patients. These flaps were anastomosed with ipsilateral superior thyroid vessels (n = 14), contralateral superior thyroid vessels (n = 16), ipsilateral superficial temporal vessels (n = 6), and ipsilateral facial vessels (n = 2). One patient had partial flap loss that was managed with local flap. Conclusion: Vessel-compromised neck is not a contraindication for free tissue transfer. Excellent results can be achieved by careful flap selection and choosing the best recipient vessel nearby using the algorithm proposed in the study. Ethics Approval and Consent to Participate:The study is in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Free tissue transfer as a vascular source for the vessel‐depleted neck

Abstract: Adequate planning and strategic selection of free flaps with long pedicles can provide the necessary vascular sources needed for future successful free flap head and neck reconstructions. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2515-E2518, 2016.

Cited by 12 publications

References 10 publications

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

Feasibility and reliability of microvascular reconstruction in the vessel-depleted previously operated neck

Microvascular Free Tissue Transfer in Vessel-Compromised Neck: Techniques and Recommendations

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