Use of Internal Mammary Vessels in Head and Neck Microvascular Reconstruction | Cardiothoracic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.173.234.169. Please contact the publisher to request reinstatement.
1.
Smith RB, Sniezek JC, Weed DT, Wax MK.Microvascular Surgery Subcommittee of American Academy of Otolaryngology–Head and Neck Surgery.  Utilization of free tissue transfer in head and neck surgery.  Otolaryngol Head Neck Surg. 2007;137(2):182-19117666238PubMedGoogle ScholarCrossref
2.
Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: techniques for achieving microvascular reconstruction.  Head Neck. 2008;30(2):201-20717972312PubMedGoogle ScholarCrossref
3.
Dolan R, Gooey J, Cho YJ, Fuleihan N. Microvascular access in the multiply operated neck: thoracodorsal transposition.  Laryngoscope. 1996;106(11):1436-14378914917PubMedGoogle ScholarCrossref
4.
Feng LJ. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.  Plast Reconstr Surg. 1997;99(2):405-4169030148PubMedGoogle ScholarCrossref
5.
Urken ML, Higgins KM, Lee B, Vickery C. Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck.  Head Neck. 2006;28(9):797-80116883607PubMedGoogle ScholarCrossref
6.
Head C, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Blackwell KE. Microvascular reconstruction after previous neck dissection.  Arch Otolaryngol Head Neck Surg. 2002;128(3):328-33111886353PubMedGoogle Scholar
7.
Alam DS, Khariwala SS. Technical considerations in patients requiring a second microvascular free flap in the head and neck.  Arch Otolaryngol Head Neck Surg. 2009;135(3):268-27319289705PubMedGoogle ScholarCrossref
8.
Horng SY, Chen MT. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction.  Plast Reconstr Surg. 1993;92(4):752-7538356138PubMedGoogle ScholarCrossref
9.
Novakovic D, Patel RS, Goldstein DP, Gullane PJ. Salvage of failed free flaps used in head and neck reconstruction.  Head Neck Oncol. 2009;1:3319698095PubMedGoogle ScholarCrossref
10.
Okazaki M, Asato H, Takushima A,  et al.  Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer.  Plast Reconstr Surg. 2007;119(4):1223-123217496594PubMedGoogle ScholarCrossref
11.
Withrow KP, Rosenthal EL, Gourin CG,  et al.  Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure.  Laryngoscope. 2007;117(5):781-78417473668PubMedGoogle ScholarCrossref
12.
Schneider DS, Wu V, Wax MK. Indications for pedicled pectoralis major flap in a free tissue transfer practice [published online ahead of print November 15, 2011].  Head Neck. 2011;Google Scholar
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
Abstract

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.

×