Revisiting the Transverse Cervical Artery and Vein for Complex Head and Neck Reconstruction

Abstract

Background Chemoradiotherapy is the primary treatment modality for glottic and pharyngeal subsites. Management of recurrence or second primaries in this setting is a surgical challenge requiring complex free flap reconstruction. One of the major barriers to effective reconstruction is the availability of suitable recipient vessels. We propose that the transverse cervical artery (TCA) is a viable option for complex head and neck reconstruction. Methods A retrospective chart review of 230 consecutive free tissue reconstructive cases was performed by the senior author (EG). Results Forty cases were identified that used the TCA for arterial anastomosis. Twenty-six patients had prior treatment, 13 of which had multimodality treatment. There were no microvasculature free flap failures and 5 minor flap complications. Conclusions Our experience with the TCA suggests it is a viable option for complex head and neck reconstruction, particularly in the setting of prior comprehensive neck dissection or radiation. In addition, the location of the TCA provides favorable pedicle geometry for microvascular anastomosis.

Transverse Cervical Artery for Head and Neck Reconstruction with Free Jejunal Flaps: A Retrospective Study of Computed Tomography Angiography

“…18 These advantages are probably associated with the anatomi-cal characteristics of the TCA that protect it from the effects of radiation and neck dissection. 20 The clinical results of the current study also demonstrated the reliability of the TCA as a recipient vessel. The current study focused on total pharyngolaryngectomy and free jejunum transfer as an established reconstruction model in which both the TCA and the external carotid system provide candidate recipient vessels.…”

“…18 These advantages are probably associated with the anatomical characteristics of the TCA that protect it from the effects of radiation and neck dissection. 20…”

“…7,17 The TCA is also selected as a recipient artery for head and neck reconstruction and is especially preferred in patients with a history of radiotherapy or neck dissection. 7,[17][18][19][20] However, the TCA is less commonly used than other arteries derived from the external carotid artery, 1,6,21 and comparisons between the TCA and branches of the external carotid artery are not well documented. Therefore, this study aimed to evaluate the reliability and utility of the TCA as a recipient artery in head and neck reconstruction by comparing operative results and the caliber of these arteries based on dynamic-enhanced computed tomography (CT).…”