Nakamura Shogo, Yasunaga Yoshichika, Nakao Junichi, Araki Jun, Mori Hiroaki, Ogino Akihiro
From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
Department of Plastic and Reconstructive Surgery, Toho University Omori Medical Center, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2025 Aug 1;13(8):e7019. doi: 10.1097/GOX.0000000000007019. eCollection 2025 Aug.
The external jugular vein (EJV) is commonly used as a recipient vein in free flap head and neck reconstruction. However, the branching patterns of the EJV vary significantly, influencing its usability during surgery. In this study, we aimed to classify the confluence patterns of the EJV by using preoperative contrast-enhanced computed tomography scans to assess its suitability as a recipient vein.
A retrospective observational study was conducted using 100 side images of 50 patients who underwent contrast-enhanced computed tomography before head and neck reconstruction between April 2022 and November 2022. EJV confluence was categorized into 4 types: subclavian vein (SCV), venous angle (junction of the SCV and internal jugular vein [IJV]), IJV, and absence of the EJV (non-EJV). The frequency of each pattern was then calculated.
The EJV drained into the SCV in 47%, the venous angle in 37%, and the IJV in 11% of cases, whereas 5% showed no EJV. In the IJV type, the proximal EJV can be ligated during neck dissection or resection of the IJV, rendering up to 16% of cases unsuitable for EJV-based microvascular anastomosis (combined IJV and non-EJV types).
Preoperative imaging is essential to confirm the confluence pattern of the EJV, particularly in cases where resection of the IJV is planned. For patients without EJV- or IJV-type patterns, alternative recipient veins should be prepared in advance to avoid intraoperative complications. This approach underscores the importance of interdisciplinary planning in head and neck reconstruction.
在游离皮瓣头颈部重建中，颈外静脉（EJV）常被用作受区静脉。然而，EJV的分支模式差异很大，影响其在手术中的可用性。在本研究中，我们旨在通过术前增强CT扫描对EJV的汇合模式进行分类，以评估其作为受区静脉的适用性。
对2022年4月至2022年11月期间50例在头颈部重建前行增强CT扫描的患者的100侧图像进行回顾性观察研究。EJV汇合分为4种类型：锁骨下静脉（SCV）、静脉角（SCV与颈内静脉[IJV]的汇合处）、IJV以及无EJV（非EJV）。然后计算每种模式的频率。
47%的病例中EJV汇入SCV，37%汇入静脉角，11%汇入IJV，而5%未显示EJV。在IJV型中，在颈部清扫或IJV切除过程中可结扎近端EJV，导致高达16%的病例不适合基于EJV的微血管吻合（IJV和非EJV型合并）。
术前影像学检查对于确认EJV的汇合模式至关重要，尤其是在计划切除IJV的病例中。对于没有EJV或IJV型模式的患者，应提前准备替代受区静脉以避免术中并发症。这种方法强调了头颈部重建中多学科规划的重要性。
