Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy

Abstract

BackgroundThe purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy.MethodsBetween January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient.ResultsAll of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up.ConclusionsIn patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

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

“…Previous reports utilizing the TCA include a series of six and nine patients with encouraging results in a vessel depleted neck. 3,4 Herein, we present a retrospective review of 230 consecutive head and neck free flap reconstruction to identify the utilization of the TCA and discuss the technique of, and advantages for, using the TCA for complex reconstructions.…”

Simultaneous double free radial forearm flaps combined with coronoidectomy and myotomy to release bilateral severe trismus: A case report

“…However, in patients with severe trismus and bilateral oral large defects and only one available recipient vessel, two small radial forearm free flaps are insufficient. To overcome the unavailability of recipient vessels in so‐called “frozen” or “vessel‐depleted” necks due to previous neck dissections, radiotherapy, or multiple reconstructions, superficial temporal vessels are usually the first choice, followed by the transverse cervical vessel, because they are distant from the scarring region (Xu et al, ). By contrast, inadequate pedicle length might require additional vein grafting, which increases the risk of the procedure because of additional microscopic anastomosis.…”

“…Wei et al (Wei, Chang, Kildal, Tsang, & Chen, 2001;Ho, Ko, Yang, Shieh, & Tsai, 2002) Surgical debulking procedure and oral commissuralpalsty of the AMT flap was performed to correct oral drooling. Maximal mouth opening was increased from 5 to 32 mm, and the patient reported a marked improvement in quality of life after a 3-year follow-up called "frozen" or "vessel-depleted" necks due to previous neck dissections, radiotherapy, or multiple reconstructions, superficial temporal vessels are usually the first choice, followed by the transverse cervical vessel, because they are distant from the scarring region (Xu et al, 2015). By contrast, inadequate pedicle length might require additional vein grafting, which increases the risk of the procedure because of additional microscopic anastomosis.…”

Lateral thoracic artery as recipient vessel for head and neck free flap reconstruction in the vessel depleted neck: A case report

“…However, it might be compromised from previous neck dissection or irradiation resulting in frozen neck or vessel depleted neck. Finding recipient vessels in a frozen neck is one of the biggest challenges (Zhong-fei et al, 2015). Anastomosing the vessels of the free flap used in head and neck reconstruction to recipient vessels outside the head and neck territory is limited by the length of the flap vascular pedicle.…”

“…Alternative recipient vessels in these cases are limited. Some alternatives have been described such as the transverse cervical vessels and the internal mammary vessels yet poor blood flow might in some instances limit the use of the transverse cervical vessels and lack of expertise might limit the use of internal mammary vessels in other cases (Jacobson, Eloy, Park, Roman, & Genden, 2008;Tessler et al, 2017;Urken, Higgins, Lee, & Vickery, 2006;Zhong-fei et al, 2015).…”