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

Head and neck reconstructionwithmicrovascular free tissue transfer has been utilized since the mid1950s. 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 e-8 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 ‘‘vesseldepleted neck’ in which the internal mammary vessels were utilized as the recipient vessels for microvascular freeflap for the reconstructionof theheadandneck 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. Internal Mammary Vessels Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction P. M. Buck: Oregon Health and Science University, M. K. Wax, D. Petrisor Introduction: The application of microvascular free tissue transfer for reconstruction of the head and neck is well established. Improved outcomes, as well as surgical and technological advances have broadened the applications of microvascular free flaps in these defects. Post-operative complications such as pharyngocutaneous fistulas, tracheal or esophageal stenoses, or recurrent pathology occasionally require secondary or even tertiary reconstruction with free tissue transfers. The disrupted anatomy and fibrotic changes resulting from primary reconstruction, neck dissection and irradiation present the surgeon with a high risk of provoking vascular or nervous injury when dissecting in previously operated or irradiated sites. This prompts a search for alternative recipient vessels for microvascular anastomosis. The transverse cervical, inferior thyroid, and arteries of the thyrocervical trunk have all been proposed[1]. The internal mammary vessels (IMVs) have a proven record in breast reconstruction but recently have found application in special circumstances in head and neck reconstruction[2]. This investigation describes the advantages of the internal mammary vessels (IMVs) as suitable recipient vessels for head and neck reconstruction when access to traditional vasculature is unavailable. Methods: We reviewed a series of 8 consecutive free flaps utilizing the IMVs spanning 2011-2013 at Oregon Health and Science University in Portland, Oregon.