Transverse cervical vascular pedicle: It's extended use as ‘second-line’ recipient vessels in thoracic and upper arm reconstructions in addition to head-and-neck reconstructions

Abstract

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.

Extending the Indication of the Superior Thyroid Artery as a Recipient Vessel for Complex Upper Body Defects

“…Our experience has shown that even caudal sternal defects can be adequately reconstructed using the STA as a recipient, provided adequate pedicel length and flap size. Our findings, thus, promote a further option for reconstruction of chest wall defects in patients that lack vessels in vicinity of the defect and add to recent studies that suggest the use of transverse cervical vessels in these cases 35 . In theory, further branches of the external carotid artery, such as the facial or lingual artery that are commonly used in head and neck reconstructions, 36 could also be considered as alternative recipients in certain cases.…”

“…Our findings, thus, promote a further option for reconstruction of chest wall defects in patients that lack vessels in vicinity of the defect and add to recent studies that suggest the use of transverse cervical vessels in these cases. 35 In theory, further branches of the external carotid artery, such as the facial or lingual artery that are commonly used in head and neck reconstructions, 36 could also be considered as alternative recipients in certain cases. However, because these branches are located more cranially, compared with the STA, pedicle length can be an issue.…”

The dominance of dorsal scapular artery as the blood supply to muscles of the back in the absence of two primary vessels: a cadaveric case report

“…The use of the TCA as an arterial flap can be spread to cover larger areas such as the anterior chest and clavicle [ 15 ]. Muppireddy et al described how the TCA is a safe vessel for arterial flaps because it can anastomose and is an easily dissectible artery due to its location [ 18 ]. Additionally, patients who undergo targeted radiation therapy or treatment for recurrent tumors of the head and neck are at increased risk of damage to the vessels of the neck, specifically the external carotid artery and its branches, therefore, utilization of the TCA is a safe option for reconstructive surgery [ 20 ].…”

“…However, the literature on the absence of the SSA and TCA is limited [ 5 ]. Knowledge of anatomical variations in the arterial supply of the neck and muscles of the back can reduce surgical error and intraoperative complications [ 15 – 18 ]. In this case report, we describe the unilateral absence of the SSA and TCA from the TCT, and branches from the DSA providing blood supply to the trapezius and supraspinatus muscle on a male donor body.…”