Minimally Invasive Approach to Access Vessels for Microvascular Anastomosis in Head and Neck Reconstruction

Abstract

ObjectivesTo describe our technique, review indications, and evaluate the outcomes of the minimal access approach for recipient vessel identification in microvascular tissue transfer.MethodsRetrospective chart review of all patients who underwent microvascular reconstruction using the minimal access technique between 2015 and 2021.ResultsWe report 236 cases, comprising 214 patients with a mean age of 60.2 years (3–88). The most common primary defect sites were the mandible (22.6%), cranium (14%), maxilla (13.2%), skull base (12.8%), and nose/nasal cavity (10.6%). Indications for free flap reconstruction included head and neck cancer extirpation (32.2%), osteoradionecrosis (29.7%), acquired deformity (14.0%), chronic wound (11.9%) and oral motor dysfunction (7.2%). Free flap donor sites used were the anterolateral thigh (84.3%), fibula (7.2%), and radial forearm (6.4%). Vessels utilized include superficial temporal (49.8%), facial (38.3%), angular (11.1%), and transverse cervical (0.4%). The overall complication rate was 14% (n = 33), with surgical complications at the recipient site accounting for 67.6% (n = 25). Flap failure occurred in 3.4% of procedures. Prior head and neck surgery and free flaps were associated with an increased risk of major recipient site complications (n = 20, p = 0.0257 and n = 14, p = 0.0117, respectively).ConclusionMinimal access techniques allow consistent recipient vessel identification for microvascular‐free tissue transfer. These approaches may be utilized in reconstructing a broad range of head and neck defects, are low morbidity, and contribute to an overall shorter length of stay.Level of Evidence2 Laryngoscope, 2023

Management of large head and neck defects in the vessel-depleted neck

“…Options can include superficial temporal, facial vessels in the contralateral neck, angular vessels, and transverse cervical vessels. Vos et al described a single institution experience with use of these nontraditional recipient vessel options with an overall free flap failure rate of 3.4% [6 ▪▪ ]. Further, previous publications describe how each of these vessels can be identified through minimal access incisions to lessen morbidity to patients [6 ▪▪ ,7].…”

“…Vos et al described a single institution experience with use of these nontraditional recipient vessel options with an overall free flap failure rate of 3.4% [6 ▪▪ ]. Further, previous publications describe how each of these vessels can be identified through minimal access incisions to lessen morbidity to patients [6 ▪▪ ,7]. Techniques for identifying each vessel system are briefly described below.…”

“…The angular vein can be identified deep and lateral to the insertion site of zygomaticus major muscle. Finally, transverse cervical vessels can be identified through a low horizontal incision posterior to the posterior border of sternocleidomastoid muscle [6 ▪▪ ,7].…”