Microvascular Reconstruction After Previous Neck Dissection

Abstract

Free flap reconstruction of the head and neck is highly successful in patients with a history of neck dissection, despite a relative paucity of potential cervical recipient blood vessels. Heavy reliance on free flaps with long vascular pedicles obviated the need to perform vein grafts in the present series, probably contributing to the absence of free flap failure. Previous neck dissection should not be considered a contraindication to microvascular reconstruction of the head and neck.

Rapid autonomisation of a combined fibular‐ and anterolateral thigh flap transferred by a wrist carrier to an irradiated and vessel depleted neck

“…Although irradiation is known to cause vascular damage to neck vessels [11,12], high success rates of free flap transfer are reported by experienced surgeons, assuming vessels suitable for microvascular anastomoses are still available [1][2][3]. However, the thoracoacromial system and cephalic vein have been proposed for direct or indirect anastomoses using loops, if the recipient vessels have already been removed during previous surgery on the patient's neck.…”

“…However, during secondary reconstruction, surgeons are often encountered with scarring and tissue fibrosis due to previous surgery and irradiation, especially on the neck of patients with oral squamous cell carcinomas. If, in these cases, vessels can still be exposed by careful dissection, success rates of treatments are described to be similar to those without radiation [1][2][3]. On the other hand, free flap transfer is far more difficult or may even become impossible, if all suitable neck vessels have already been removed in former operations.…”

Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

“…These flaps provide consistent, vascular pedicles with adequate length and diameter. 3,4,6,7,19 As soft-tissue defects are usually superficial, the direction and pedicle of these flaps can more easily be changed during inset so as to reach the vessels more easily (see Fig. 4).…”

“…4,5,7,9,20,21 In previously irradiated necks the recipient vessel identification and dissection was a rather tedious procedure but it is not as difficult as was once imagined. It does however require more delicate dissection and in some cases must be performed using a surgical microscope.…”

Head and neck reconstruction using cephalic vein transposition in the vessel‐depleted neck

“…1,2 The recipient vessels are branches of the external carotid artery, the external jugular vein (EJV), and the internal jugular vein (IJV). In our experience with free ileocolic transfer the use of larger veins results in fewer complications hence the EJV and IJV are more frequently used; for instance in free jejunal transfer the EJV and IJV are usually the only vessels larger in diameter than the jejunal vein, alleviating vessel size mismatch.…”