Arch Craniofac Surg.  2020 Oct;21(5):269-275. 10.7181/acfs.2020.00339.

Recipient vessel selection for head and neck reconstruction: A 30-year experience in a single institution

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Seoul, Korea

Abstract

Background
The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects.
Methods
In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient’s demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed.
Results
Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n= 107), followed by the anterolateral thigh flap (n= 18) and fibula flap (n= 10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis.
Conclusion
Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.

Keyword

Free tissue flap; Head and neck cancer; Microsurgery; Neck dissection
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