Use of a combined latissimus dorsi scapular free flap revascularized with vein grafting to the internal mammary artery in a vessel‐depleted and previously irradiated neck

• Published in: Head & neck Vol. 35; no. 11; pp. E328 - E332
• Main Authors: Karle, William E., Anand, Sumeet M., Clain, Jason B., Scherl, Sophie, Buchbinder, Daniel, Smith, Mark L., Urken, Mark L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2013
• Subjects: Aged; Anastomosis, Surgical - methods; Female; Follow-Up Studies; Free Tissue Flaps - blood supply; Free Tissue Flaps - transplantation; Graft Survival; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - surgery; Humans; internal mammary vessels; latissimus dorsi scapular free flap; Male; Mammary Arteries - surgery; Mammary Arteries - transplantation; microvascular reconstruction; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Radiotherapy, Adjuvant; Reconstructive Surgical Procedures - methods; Superficial Back Muscles - blood supply; Superficial Back Muscles - transplantation; Tissue and Organ Harvesting - methods; Treatment Outcome; vein graft; Veins - surgery; Veins - transplantation; vessel‐depleted neck; Wound Healing - physiology; microvascular reconstruction; latissimus dorsi scapular free flap; vessel-depleted neck; internal mammary vessels; vein graft
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.23194

Background For patients who have extensive prior treatment, use of the internal mammary artery/vein (IMA/IMV) or cephalic vein has been shown to be a reliable option. Additionally, for those patients who require vascularized bone and extensive soft tissue reconstruction, the combined latissimus dorsi scapular free flap (mega‐flap) is an excellent option. Methods We reviewed 3 cases in which extensive prior surgery and radiation precluded the use of traditional recipient vessels in the neck. Results Three patients with major jaw deformities were reconstructed using a mega‐flap. In all cases, saphenous vein grafting succeeded in achieving arterial inflow from the IMA to the subscapular artery. Venous egress was achieved using a vein graft to the IMV in 1 patient and a transposed cephalic vein in the remaining 2 patients. Conclusions This approach of restoring large oral cavity defects for patients with extensive prior therapy and comorbid conditions has proven to be reliable and reproducible. © Wiley Periodicals Inc. Head Neck, 35: E328–E332, 2013