Background:Selection of recipient vessels is one of the key factors for a successful microvascular reconstruction. Non-availability of primary recipient vessels in the vicinity necessitates surgeon to approach a remote second-line vascular access. Transverse cervical vessels (TCV) have been described as second-line vascular access for head-and-neck reconstructions. Due to its location, their use can be extended to the proximal chest and upper arm reconstructions.Aim:The aim of the study is to analyse the reliability of TCV as second-line recipient vessels for the upper arm and chest reconstructions in addition to the head-and-neck reconstructions.Materials and Methods:During 2010–2017, 14 TCV were explored as the choice of second-line recipient pedicle for specific indications. Clinical experience with different reconstructions discussed.Results:Out of 14 transverse cervical arteries, 13 were of adequate size for anastomosis. About 12 successful reconstructions were performed involving the head and neck (7), proximal thorax (3) and upper arm (2) for indications such as scarring from different aetiology (8), previous free flaps (2) and sacrificed vessels (2). In one case, the arterial anastomosis was shifted to superior thyroid artery. All the chest and upper arm reconstructions needed a realignment of the pedicle without any kink. Transverse cervical vein (TCv) could be used only 5/14 times either alone or along with external jugular vein (EJV). In other cases, EJV alone was used. All the 12 flaps survived without any vascular event.Conclusions:Transverse cervical vessels are reliable second-line recipient vessels in the head and neck; in addition, they are of use in the upper arm and proximal chest defects.
Background: Coverage of soft tissue defects of the foot and ankle has imposed a challenging situation to the plastic surgeon. Some patients have contraindications for microsurgery, thus limiting the options for local tissue transfer. The Reverse sural artery flap is frequently used for reconstruction of distal third leg, ankle, and heel. The major disadvantage of RSA flap is compression of pedicle within subcutaneous tunnel leading to venous congestion and distal flap necrosis. To overcome this problem, we describe an interpolation flap technique in which subcutaneous tunneling of neurovascular structures is avoided. Methods: 13 cases of distally based RSA flaps as interpolation flap were performed for soft tissue defects in dorsum of foot, heel pad, malleoli, and TA region during the period 2014 to 2016. Results: With this procedure no flap loss was observed in this series and only a few minor complications occurred. The pedicle is divided in a second stage operation. Conclusions: We conclude that transferring the flap in 2 stages without use of tunnel improves the reliability of flap and decreases the chances of necrosis.
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