Recipient vessel selection for head and neck reconstruction: A 30-year experience in a single institution

Abstract

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects.

Methods: In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient's demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed.

Results: Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n= 107), followed by the anterolateral thigh flap (n= 18) and fibula flap (n= 10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis.

Conclusion: Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.

Keywords: Free tissue flap; Head and neck cancer; Microsurgery; Neck dissection.

Fig. 1.

Use of Carotid artery as the recipient vessel in vessel-depleted neck at second operation. Because suitable recipient arteries were sacrificed in the prior surgery, the ipsilateral carotid artery was chosen as the recipient artery. End-to-side arterial anastomosis was performed as quickly as possible.

Fig. 2.

Use of internal jugular vein (IJV) as an alternative recipient vessel. (A) Venous thrombosis of flap was seen in a day after reconstruction. In intraoperative view, venous thrombosis was found in external jugular vein and venous anastomosis site. (B) Thrombectomy and massive heparin irrigation were conducted, and two venous re-anastomosis was performed to IJV in an end-to-side fashion. After exploration, venous congestion resolved and flap survived without any complications.