The Utilization of the Internal Mammary Vessels for Head and Neck Microvascular Reconstruction in the Vessel-depleted Neck

The Utilization of the Internal Mammary Vessels for Head and Neck Microvascular Reconstruction in the Vessel-Depleted Neck

 

Abstract:  Head and neck reconstruction with microvascular free tissue transfer has been utilized since the mid-1950s. Microvascular free flaps have become the current standards for head and neck reconstruction, with survival rates that have been reported to be greater than 95%. However, scaring and fibrosis secondary to previous surgery, radiation therapy, and chronic infection, ultimately lead to the clinical situation known as the “vessel-depleted neck,” forcing the microvascular surgeons to search for recipient vessels outside the routine locations leading to reduction in success rates.  The internal mammary artery vessels were first described as recipient vessels in breast microvascular reconstruction and recently have been described as the “first-choice” recipient vessels for those procedures. In the situation of the “vessel-depleted neck” patient we advocate the use of the internal mammary artery as the primary recipient vessels. In this retrospective study we demonstrate the efficacy and effectiveness of the internal mammary recipient vessels for microvascular anastomosis of free flaps for the reconstruction of the head and neck. We will present the different techniques of harvesting these vessels and guide in decision-making when approaching a vessel-depleted neck.

Patients and Methods: The present study was a retrospective review of patients treated at the Oral and Maxillofacial Surgery Department at the University of Miami Miller School of Medicine, during a 3-year period between 2010 and 2013.  We identified seven patents with “vessel-depleted neck” in which the internal mammary vessels were utilized as the recipient vessels for microvascular free flap for the reconstruction of the head and neck region. Sex, age, diagnosis, defect, prior neck surgery, prior radiation therapy, type of free flap used, donor site complications, patient morbidity and flap survival were evaluated.

RESULTS:  Successful free-tissue transfers resulted in all cases; no donor or recipient site complications were noticed. In one patient, retrograde internal mammary vessels was used due to the damaged anterograde vessels.

CONCLUSION: The internal mammary vessels are excellent recipient vessels for microvascular reconstruction of the head and neck , with minimal morbidity,  and should be considered in vessel-depleted necks.