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Original Article
Feb 2012

Use of Internal Mammary Vessels in Head and Neck Microvascular Reconstruction

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland (Drs Schneider and Wax); University of Mississippi Medical School, Jackson (Ms McClain); and Department of Otolaryngology–Head and Neck Surgery, University of Alabama, Birmingham (Mr Robb and Dr Rosenthal).

Arch Otolaryngol Head Neck Surg. 2012;138(2):172-176. doi:10.1001/archoto.2011.1150

Objective To describe the use of the internal mammary vessels (IMVs) in microvascular head and neck reconstruction in a small case series with select donor sites.

Design Retrospective medical record review study.

Setting Oregon Health and Science University and University of Alabama.

Patients Patients for whom IMVs were used for head and neck reconstruction from January 1, 1998, through December 31, 2010.

Main Outcome Measures Intraoperative or postoperative complications, flap survival, and morbidity due to the flap.

Results Of 2721 free tissue transfers, 55 (2%) (in 48 patients) used IMVs. Use of IMVs was associated with ablative surgery with sternal resection (25 of 55 [45%]), a vessel depleted neck (23 of 55 [42%]), and fistula repair with gross contamination due to prior flap failure or chronic pharyngocutaneous fistula with vessel depleted neck (7 of 55 [13%]). Flaps included radial forearm (33 of 55 [60%]), jejunum (9 of 55 [16]), ulnar (5 of 55 [9%]), and other (8 of 55 [14%]). No vein grafts were used. Pneumothorax developed in 1 patient (2%). Postoperative fistulas were observed in 14 of 48 patients (29%); the fistulas healed conservatively in 7 patients (50%), rotation of flap tissue was required in 2 patients (14%), and the fistulas persisted in 5 patients (36%). The flap survival rate was 98%.

Conclusion Internal mammary vessels provide reliable recipient vessels for cervical and sternal microvascular reconstruction.