[The internal thoracic vessels as alternative recipient vessels for microsurgical reconstruction in the head and neck area in patients with a vessel-depleted neck].

The microsurgical reconstruction of defects in the head and neck area after local recurrent or secondary tumours is a very demanding procedure, since the recipient vessels for free flap transfer are usually absent, strongly damaged or because of previous radiation therapy very vulnerable. In these cases, it is often necessary to search an alternative to the classical recipient vessels--branches of the external carotid artery and internal and external jugularis vein. The authors present a clinical series where the internal mammary vessels were chosen as free flap recipient in the vessel-depleted neck. 11 patients were examined, in whose the extended dissected internal mammary vessels were selected as recipient for free flaps. There was no flap loss in the series. A venous anastomosis had to be revised due to bleeding on the fourth postoperative day. In one patient both sides were used simultaneously for 2 different flaps (jejunum+VRAM "vertical rectus abdominis myocutaneous flap"). Despite the general opinion that this procedure has disadvantages--like short pedicle and morbidity of the donor side at the thoracic wall--which could bring intra- and postoperative complications, it shows that in patients with previous surgeries or radiation therapy of the neck the internal mammary (after further distal preparation) as recipient vessels represent an attractive alternative to the A-V Loops.