The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck

Pedro Ciudad, Mouchammed Agko, Oscar J Manrique, Shivprasad Date, Kidakorn Kiranantawat, Wei Ling Chang, Fabio Nicoli, Federico Lo Torto, Michele Maruccia, Georgios Orfaniotis, Hung-Chi Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck.

METHODS: Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively.

RESULTS: There was 100% flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period.

CONCLUSIONS: In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.

Original languageEnglish (US)
Pages (from-to)902-909
Number of pages8
JournalMicrosurgery
Volume37
Issue number8
DOIs
StatePublished - Nov 2017
Externally publishedYes

Fingerprint

Neck
Arteries
Head
Radiation Pneumonitis
Perforator Flap
Fibula
Neck Dissection
Contracture
Thigh
Sutures
Veins
Radiotherapy
Survival Rate
Tissue Donors
Morbidity
Transplants
Infection

Keywords

  • Adult
  • Aged
  • Contracture/pathology
  • Female
  • Free Tissue Flaps/blood supply
  • Head and Neck Neoplasms/pathology
  • Humans
  • Male
  • Microsurgery
  • Middle Aged
  • Neck Dissection
  • Reconstructive Surgical Procedures
  • Retrospective Studies
  • Treatment Outcome

Cite this

The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck. / Ciudad, Pedro; Agko, Mouchammed; Manrique, Oscar J; Date, Shivprasad; Kiranantawat, Kidakorn; Chang, Wei Ling; Nicoli, Fabio; Lo Torto, Federico; Maruccia, Michele; Orfaniotis, Georgios; Chen, Hung-Chi.

In: Microsurgery, Vol. 37, No. 8, 11.2017, p. 902-909.

Research output: Contribution to journalArticle

Ciudad, P, Agko, M, Manrique, OJ, Date, S, Kiranantawat, K, Chang, WL, Nicoli, F, Lo Torto, F, Maruccia, M, Orfaniotis, G & Chen, H-C 2017, 'The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck', Microsurgery, vol. 37, no. 8, pp. 902-909. https://doi.org/10.1002/micr.30193
Ciudad, Pedro ; Agko, Mouchammed ; Manrique, Oscar J ; Date, Shivprasad ; Kiranantawat, Kidakorn ; Chang, Wei Ling ; Nicoli, Fabio ; Lo Torto, Federico ; Maruccia, Michele ; Orfaniotis, Georgios ; Chen, Hung-Chi. / The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck. In: Microsurgery. 2017 ; Vol. 37, No. 8. pp. 902-909.
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abstract = "BACKGROUND: Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck.METHODS: Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively.RESULTS: There was 100{\%} flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period.CONCLUSIONS: In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.",
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T1 - The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck

AU - Ciudad, Pedro

AU - Agko, Mouchammed

AU - Manrique, Oscar J

AU - Date, Shivprasad

AU - Kiranantawat, Kidakorn

AU - Chang, Wei Ling

AU - Nicoli, Fabio

AU - Lo Torto, Federico

AU - Maruccia, Michele

AU - Orfaniotis, Georgios

AU - Chen, Hung-Chi

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2017/11

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N2 - BACKGROUND: Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck.METHODS: Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively.RESULTS: There was 100% flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period.CONCLUSIONS: In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.

AB - BACKGROUND: Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck.METHODS: Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively.RESULTS: There was 100% flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period.CONCLUSIONS: In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.

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KW - Humans

KW - Male

KW - Microsurgery

KW - Middle Aged

KW - Neck Dissection

KW - Reconstructive Surgical Procedures

KW - Retrospective Studies

KW - Treatment Outcome

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