The Utilization of the Internal Mammary Vessels for Head and Neck Microvascular Reconstruction in the Vessel-Depleted Neck

Abstract

Head and neck reconstruction with microvascular free tissue transfer has been utilized since the mid-1950s. Microvascular free flaps have become the current standards for head and neck reconstruction, with survival rates that have been reported to be greater than 95%. However, scaring and fibrosis secondary to previous surgery, radiation therapy, and chronic infection, ultimately lead to the clinical situation known as the “vessel-depleted neck,” forcing the microvascular surgeons to search for recipient vessels outside the routine locations leading to reduction in success rates. The internal mammary artery vessels were first described as recipient vessels in breast microvascular reconstruction and recently have been described as the “first-choice” recipient vessels for those procedures. In the situation of the “vessel-depleted neck” patient we advocate the use of the internal mammary artery as the primary recipient vessels. In this retrospective study we demonstrate the efficacy and effectiveness of the internal mammary recipient vessels for microvascular anastomosis of free flaps for the reconstruction of the head and neck. We will present the different techniques of harvesting these vessels and guide in decision-making when approaching a vessel-depleted neck.