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. 2020 Jan-Jun;10(1):96-101.
doi: 10.4103/ams.ams_201_19. Epub 2020 Jun 8.

Feasibility and Reliability of Microvascular Reconstruction in the Vessel-depleted Previously Operated Neck

Thyagraj Jayaram Reddy  1 , Ehtaih Sham  2 , Mandakulutur S Ganesh  3 , P Suresh Menon  2 , Karthik Vishwas Gowda  2 , Rayan Malick  2
Affiliations

Feasibility and Reliability of Microvascular Reconstruction in the Vessel-depleted Previously Operated Neck

Thyagraj Jayaram Reddy et al. Ann Maxillofac Surg. 2020 Jan-Jun.

Abstract

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.

Keywords: Free flaps; microvascular surgery; neck dissection; recurrence; vessel compromised neck.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Post radiation defect, (b) vertical rectus abdominis flap, (c) vertical rectus abdominis myocutaneous flap pedicle, (d) donor site closer, and (e) flap in situ
Figure 2
Figure 2
(a) Recurrent squamous cell carcinoma, (b) resection markings, (c) Specimen, (d) radial forearm free flap, (e) flap in situ
Figure 3
Figure 3
(a) Recurrent squamous cell carcinoma, (b) Specimen, (c) neck clearance, (d) radial forearm free flap, (e) fibula reconstruction, and (f) final closure with double flap
See this image and copyright information in PMC

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