Martinez Daniel C, Badhey Arvind, Cervenka Brian, Zender Chad, Tang Alice, Patil Yash
Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Facial Plast Surg. 2020 Dec;36(6):746-752. doi: 10.1055/s-0040-1721108. Epub 2020 Dec 24.
The vessel-depleted neck presents a unique and challenging scenario for reconstructive surgery of the head and neck. Prior surgery and radiation often result in significant scarring and damage to the neck vasculature, making identification of suitable recipient vessels for microvascular free tissue transfer exceedingly difficult. Therefore, alternative reconstructive techniques and/or vessel options must be considered to obtain a successful reconstructive outcome for a patient. In this article, we discuss our experience and approach to the management of the vessel-depleted neck, emphasizing the importance of preoperative planning and having multiple backup options prior to surgery. The various preoperative imaging modalities and available options for recipient arteries and veins are presented in detail. Additionally, we discuss modifications of select free flaps to maximize their utility in successful reconstruction. Together with thoughtful preoperative planning, these techniques can help aid the reconstructive surgeon in addressing the complex decisions associated with the vessel-depleted neck.
血管缺失的颈部给头颈重建手术带来了独特且具有挑战性的情况。先前的手术和放疗常常导致颈部严重瘢痕形成以及血管系统受损，使得为微血管游离组织移植识别合适的受区血管极其困难。因此，必须考虑采用替代的重建技术和/或血管选择，以便为患者获得成功的重建效果。在本文中，我们讨论了我们处理血管缺失颈部的经验和方法，强调了术前规划以及在手术前拥有多种备用方案的重要性。详细介绍了各种术前成像方式以及受区动脉和静脉的可用选择。此外，我们还讨论了对特定游离皮瓣的改良，以最大限度地提高其在成功重建中的效用。通过精心的术前规划，这些技术有助于重建外科医生应对与血管缺失颈部相关的复杂决策。
