Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review

Abstract

Head and neck defect reconstruction is a common challenge for plastic surgeons. Microsurgical free tissue transfer is a frequently used solution but its success strictly depends on the quality of recipient vessels. A particularly demanding situation occurs when there are no nearby available vessels because of previous extensive neck dissection and radiotherapy. In similar cases, it is necessary to resort to other and farther vessels. Common alternatives might be the thoraco‐acromial vessels, the transverse cervical vessels, and the internal mammary vessel. Recently, the perforator vessels of the internal mammary artery and vein were shown to be safe alternatives as recipient vessels for autologous breast reconstruction, causing less morbidity and allowing adequate perfusion of rather large flaps. Here we present a floor of the mouth reconstruction after cancer relapse resection. In this case, we employed a chimeric anterolateral thigh (ALT) free flap anastomosed to the internal mammary perforator vessels in end‐to‐end fashion. A 46‐years‐old male patient presented a defect in the floor of the mouth and base of the tongue after cancer removal. No nearby vessels were available because of extensive fibrosis and damages due to previous surgeries and radiotherapy. Therefore, on the basis of our experience in autologous breast reconstruction, we chose the internal mammary perforator vessels in the recipient side and we harvested a chimeric ALT‐based skin island then split into two parts for mouth reconstruction and monitoring. We performed the anastomosis resorting to internal mammary perforator vessels and we obtained a satisfactory result from both the functional and aesthetic point of view. Postoperative course was uneventful and at 6 months follow up the reconstructive result was good with no functional issue. We believe that this might be a valid and modern evolution of the use of internal mammary vessels as recipient vessels and that it is a worthy addition in the field of perforator‐anastomosed flaps, extending its application also to head and neck reconstructions. Moreover, a brief literature review about alternative recipient vessels for depleted neck is also provided.

Transferring pectoral muscle flap to depleted neck to create a new recipient source for free flaps in head and neck reconstruction

“…It has also limitations such as tortuous artery, thin and fragile vein and tendency for vasospasm (Kushida-Contreras et al, 2021). Internal mammary artery ( _ IMA), which is another option, has also some disadvantages such as need for rib removal, risk of pneumothorax and need of vein grafts to reach (Ibrahim et al, 2019;Scaglioni et al, 2021). Harris et al, 2002;Numajiri et al, 2009;Onoda et al, 2011).…”

Application of the “Open‐Y” technique in recipient perforator vessels: A comparison study between “Open‐Y” and conventional end‐to‐end anastomosis in terms of postoperative complications

“…Because of the delicacy and small dimension of these vessels the dissection can be particularly demanding, even more for the harvest of chimeric flaps (Scaglioni, Barth, & Giovanoli, 2019). The use of different vessels has been already described, especially in the head and neck reconstruction setting (Scaglioni, Meroni, Fritsche, & Rajan, 2020), but the amount of data present in the literature is still relatively limited.…”

Pedicled superficial circumflex iliac artery perforator flap combined with lymphovenous anastomosis between the recipient site lymphatic vessels and flap superficial veins for reconstruction of groin/thigh tissue defect and creation of lymph flow‐through to reduce lymphatic complications: A report of preliminary results

“…Over the last few years there was a clear tendency towards the use of perforator‐based flaps in the reconstructive field. They are nowadays safe and offer a series of important advantages such as shorter surgery time, less donor site morbidity, very low risk of major vessel injury, less postoperative complications, smaller skin incision, and multiple tissue transfers (Hong & Koshima, 2010; Scaglioni et al, 2021). The SCIP flap offers a series of advantages that can be summarized as follow: it is relatively simple and quick to harvest, its thickness and extension can be tailored according to need, it is very pliable, the donor site morbidity is low, and the aesthetic result is good, with a remaining scar easy to hide (Koshima et al, 2004).…”

“…Over the last few years there was a clear tendency towards the use of perforator-based flaps in the reconstructive field. They are nowadays safe and offer a series of important advantages such as shorter surgery time, less donor site morbidity, very low risk of major vessel injury, less postoperative complications, smaller skin incision, and multiple tissue transfers (Hong & Koshima, 2010;Scaglioni et al, 2021).…”