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World Journal of Surgical Oncology

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Open Access 01-12-2015 | Technical innovations

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

Authors: Zhong-fei Xu, Wei-yi Duan, En-jiao Zhang, Shuang Bai, Yu Tian, Xue-xin Tan, Fa-yu Liu, Chang-fu Sun

Published in: World Journal of Surgical Oncology | Issue 1/2015

Abstract

Background

The 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.

Methods

Between 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.

Results

All 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.

Conclusions

In 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.

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350:1937–44.PubMedCrossRef

Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery. 2007;27:588–94.PubMedCrossRef

Yazar S, Wei FC, Chen HC, Cheng MH, Huang WC, Lin CH, et al. Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects. Plast Reconstr Surg. 2005;115:1553–61.PubMedCrossRef

Urken ML, Higgins KM, Lee B, Vickery C. Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck. Head Neck. 2006;28:797–801.PubMedCrossRef

Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg. 2004;52:148–55. discussion 156-147.PubMedCrossRef

Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: techniques for achieving microvascular reconstruction. Head Neck. 2008;30:201–7.PubMedCrossRef

Yu P. The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients. Plast Reconstr Surg. 2005;115:1253–8.PubMedCrossRef

Di Martino E, Sellhaus B, Hausmann R, Minkenberg R, Lohmann M, Esthofen MW. Survival in second primary malignancies of patients with head and neck cancer. J Laryngol Otol. 2002;116:831–8.PubMedCrossRef

Vaamonde P, Martin C, del Rio M, LaBella T. Second primary malignancies in patients with cancer of the head and neck. Otolaryngol Head Neck Surg. 2003;129:65–70.PubMedCrossRef

10.

Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery. 2009;29:1–7.PubMedCrossRef

11.

Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg. 2011;27:47–56.PubMedCrossRef

12.

Roche NA, Houtmeyers P, Vermeersch HF, Stillaert FB, Blondeel PN. The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2012;65:885–92.PubMedCrossRef

13.

Agostini T, Agostini V. Cephalic vein transposition in head and neck microsurgery: advantages of a modified step-wise (closed) technique. J Plast Reconstr Aesthet Surg. 2009;62:625.PubMedCrossRef

14.

Harris JR, Lueg E, Genden E, Urken ML. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002;128:319–23.PubMedCrossRef

15.

Shimizu F, Lin MP, Ellabban M, Evans GR, Cheng MH. Superficial temporal vessels as a reserve recipient site for microvascular head and neck reconstruction in vessel-depleted neck. Ann Plast Surg. 2009;62:134–8.PubMedCrossRef

16.

Nakayama B, Kamei Y, Toriyama K, Hyodo I, Hasegawa Y, Torii S. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck. Plast Reconstr Surg. 2002;109:1246–53.PubMedCrossRef

17.

Wolff KD, Mucke T, Lehmbrock J, Loeffelbein DJ, Kesting MR, Holzle F. Rapid autonomisation of a combined fibular- and anterolateral thigh flap transferred by a wrist carrier to an irradiated and vessel depleted neck. J Surg Oncol. 2009;99:123–6.PubMedCrossRef

18.

Germann G, Steinau HU. The clinical reliability of vein grafts in free-flap transfer. J Reconstr Microsurg. 1996;12:11–7.PubMedCrossRef

19.

Huelke DF. A study of the transverse cervical and dorsal scapular arteries. Anat Rec. 1958;132:233–45.PubMedCrossRef

20.

Wong CH, Lin JY, Wei FC. The bottom-up approach to the suprafascial harvest of the radial forearm flap. Am J Surg. 2008;196:e60–4.PubMedCrossRef

21.

Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004;26:759–69.PubMedCrossRef

22.

Xu ZF, Sun CF, Duan WY, Zhang EJ, Dai W, Zheng XJ, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg. 2013;51:725–30.PubMedCrossRef

23.

Harish K. Neck dissections: radical to conservative. World J Surg Oncol. 2005;3:21.PubMedCentralPubMedCrossRef

24.

Bajwa MS, McMillan R, Khattak O, Thomas M, Krishnan OP, Webster K. Neck recurrence after level I-IV or I-III selective neck dissection in the management of the clinically n0 neck in patients with oral squamous cell carcinoma. Head Neck. 2011;33:403–6.PubMed

Title: Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy
Authors: Zhong-fei Xu
Wei-yi Duan
En-jiao Zhang
Shuang Bai
Yu Tian
Xue-xin Tan
Fa-yu Liu
Chang-fu Sun
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2015
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-015-0576-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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