Prince Andrew D P, Broderick Michael T, Neal Molly E Heft, Spector Matthew E
University of Michigan Medical School.
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Front Oral Maxillofac Med. 2020 Aug;2. doi: 10.21037/fomm-20-38.
Microvascular free tissue transfer has revolutionized reconstruction and subsequently functional outcomes in the head and neck, but requires suitable recipient vessels for successful results. Recipient vessels can be significantly compromised by prior surgery, radiation therapy, or existing and/or underlying vascular disease in the neck. When further microvascular reconstruction is required in the vessel-depleted neck, identification of appropriate vessels for anastomosis can be difficult and can present complex decisions for the surgeon as well as the patient. In this article, we review the available literature on the vessel depleted neck and the possible vessel options. We present critical strategies for preoperative treatment planning and vessel selection in these patients. We also discuss the benefits and limitations of arterial and venous options while commenting on our unique institution's experiences. The external carotid branches as well as the available subclavian artery branches are presented in detail. The venous anatomy is also described, with particular focus on the accompanying veins and cephalic vein. We provide guidance on the selection and modification of free flaps to achieve the greatest function and cosmetic outcomes in the vessel depleted neck. Our collection of advanced management techniques will provide surgeons with more options to manage the complexity of the vessel depleted neck, and to further help patients understand the risk and benefits of these selections.
微血管游离组织移植彻底改变了头颈部的重建方式及后续功能结果，但要取得成功需要合适的受区血管。先前的手术、放射治疗或颈部现有的和/或潜在的血管疾病会严重损害受区血管。当血管缺失的颈部需要进一步进行微血管重建时，识别合适的吻合血管可能很困难，对外科医生和患者来说都可能带来复杂的决策。在本文中，我们回顾了关于血管缺失颈部的现有文献以及可能的血管选择。我们提出了这些患者术前治疗规划和血管选择的关键策略。我们还讨论了动脉和静脉选择的益处和局限性，并分享了我们独特机构的经验。详细介绍了颈外动脉分支以及可用的锁骨下动脉分支。还描述了静脉解剖结构，特别关注伴行静脉和头静脉。我们提供了关于游离皮瓣选择和改良的指导，以在血管缺失的颈部实现最大功能和美容效果。我们收集的先进管理技术将为外科医生提供更多选择，以应对血管缺失颈部的复杂性，并进一步帮助患者了解这些选择的风险和益处。
