Department of Plastic and Reconstructive Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
J Plast Reconstr Aesthet Surg. 2013 Sep;66(9):1243-7. doi: 10.1016/j.bjps.2013.05.034. Epub 2013 Jun 13.
The frozen neck secondary to prior neck irradiation and surgery is not uncommon in head and neck surgery. Identifying the optimal and alternative recipient vein in patients with difficult necks is one of most important steps in preceding a free flap for head and neck reconstruction.
This is a retrospective study. From January 2006 to October 2011, the authors performed 544 cases of free flap reconstruction for head and neck cancer. The indications for choosing the retrograde limb of the superficial temporal vein as recipient vein were: (1) the flap pedicle contained only one vein 'and' (2) the patient had frozen neck or vessel-depleted neck from surgery. Amongst them, 10 patients with difficult neck where the retrograde limb of the superficial temporal vein was used as the only recipient vein for outflow were collected for the study.
The mean age was 51.7 years. The types of flaps included the anterolateral thigh (ALT) flap (n = 6), anteromedial thigh (AMT) flap (n = 1), medial sural perforator flap (n = 1) and trapezius perforator flap (n = 1). One flap needed take-back due to haematoma compression of the pedicle. All nine flaps survived completely.
The retrograde limb of the superficial temporal vein used as the only recipient vein served as an alternative option for venous return to precede a successful free flap reconstruction in difficult neck cases. The presence of valves in the vein system in the head and neck does not seem to preclude the use of retrograde flow anastomosis in patients with frozen neck.
由于先前的颈部放疗和手术，颈部冷冻在头颈部手术中并不少见。在进行头颈部重建的游离皮瓣之前，识别颈部困难患者的最佳和替代受体静脉是最重要的步骤之一。
这是一项回顾性研究。作者自 2006 年 1 月至 2011 年 10 月，共进行了 544 例头颈部癌症游离皮瓣重建。选择颞浅静脉逆行支作为受体静脉的适应证为：（1）皮瓣蒂仅含一条静脉；（2）患者因颈部冷冻或血管耗竭而手术。其中，收集了 10 例因颈部困难而将颞浅静脉逆行支作为唯一流出受体静脉的患者进行研究。
患者的平均年龄为 51.7 岁。皮瓣类型包括股前外侧皮瓣（n=6）、股前内侧皮瓣（n=1）、腓肠内侧穿支皮瓣（n=1）和斜方肌穿支皮瓣（n=1）。1 例因皮瓣蒂血肿压迫而需要取回。9 例皮瓣全部完全存活。
颞浅静脉逆行支作为唯一的受体静脉，为颈部困难病例成功进行游离皮瓣重建提供了静脉回流的替代选择。头颈部静脉系统中瓣膜的存在似乎并不排除在颈部冷冻患者中使用逆行血流吻合术。
