Arch Hand Microsurg.  2020 Dec;25(4):314-319. 10.12790/ahm.20.0059.

Free Flap Reconstruction of a Challenging Defect in the Posterior Cervicothoracic Region Using the Transverse Cervical Artery

• Lee NH
• Seo DH
• Roh SG
• Chang SC
• Shin JY

• KMID: 2508947
• DOI: http://doi.org/10.12790/ahm.20.0059

Abstract

Reconstructions of large defects located in the posterior cervicothoracic region still present challenges to plastic surgeons. The local or regional flap is preferred in the posterior cervicothoracic region and many surgeons are reluctant to perform reconstruction using a microvascular free flap because of various reasons including vascular paucity. We report a case of a 60-year-old patient with the chronic wound at posterior cervicothoracic region. An anterolateral thigh free flap was considered the best available reconstructive method due to the size of the defect and the possibility of damaging the dorsal scapular artery. We used the transverse cervical artery and jugular vein as recipient vessels and the better result was shown than that of regional or local flaps. In our report, we presented that the transverse cervical artery which didn’t have commonly used can provide a reliable and advantageous recipient artery for the microvascular free flap reconstruction of posterior cervicothoracic defects.

Keyword

Thoracic injuries; Surgical wound dehiscence; Microsurgical free flaps

Figure

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  Fig. 1. (A) Magnetic resonance imaging visualized T5 and T6 cord compression by a recurred tumor mass at the T6 vertebra. (B) C6 to T10 spinal stabilization with orthopedic hardware after surgical decompression.

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  Fig. 2. The wound was grossly 2.5×2.5 cm in size but had a 20×30 cm-sized rhomboid dead space (line).

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  Fig. 3. (A) The size of the defect after resection and debridement was 18×12 cm with a horizontal axis. And in the right neck area, the transverse cervical artery (arrowhead) and external jugular vein (arrow) was explored for the microvascular free flap (B).

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  Fig. 4. The wound was followed at 1 month postoperatively and showed a satisfactory result.

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