Free Tissue Transfer to the Head and Neck for Patients with a History of Prior Neck surgery

Abstract

Head and neck reconstruction by free tissue transfer is an important technique also for patients with a history of prior head and neck surgery. In these cases, careful attention must be paid to preparing the recipient vessels and to preventing infection. In this retrospective study, we analyzed our experiences of using free tissue transfer for patients with a history of head and neck surgery and indications of these surgeries were assessed. From 1997 to 2004, we performed 16 surgeries with free tissue transfer for head and neck reconstruction in patients with a history of prior head and neck surgery. Fifteen of these patients were male patients and one was female. Mean and standard deviation of age was 66.4 and 14.2 years. Nine of these surgeries were done for recurrence of cancer, 4 were done for post-operative fistulae, and 3 were done for the development of a second primary head and neck cancer. Although the success of these surgeries depends on several factors, one of the most critical steps is careful selection and isolation of the recipient vessels in the head and neck. In our experience, we often use the transverse cervical artery. This artery is usually preserved in the initial neck dissection, and can be relatively easily isolated even in the dissected field at a second surgery. We often choose the internal jugular vein as the recipient vein and perform end-to-side anastomosis. Preventing inflammation of the operative area is also crucial. In the cases described above, free jejunum was totally necrosed by post-operative infection in the region of the microvascular pedicle, however, all free tissue transfers were successful after controlling the infection.