Use of Internal Mammary Vessels in Head and Neck Microvascular Reconstruction

Abstract

Internal mammary vessels provide reliable recipient vessels for cervical and sternal microvascular reconstruction.

Facing a “Vessel Challenged Neck” in Head and Neck Microsurgical Reconstruction: Chang Gung Concepts, Approach, and Systematic Review

“…One of the largest published series evaluating the use of the internal mammary vessels in head and neck microvascular reconstruction included 23 patients undergoing secondary or tertiary reconstructions. 19 In this cohort, Schneider et al demonstrated that the IMA/IMV system could be reliably accessed with high success rates and without the need for interposition vein grafts, owing to the adequate pedicle length of flaps such as the anterolateral thigh (ALT) or radial forearm flap. 19 Roche et al, Urken et al, and Yagi et al also reported comparable results in head and neck reconstruction, with 100% flap survival.…”

“…Roche et al and Schneider et al both documented successful anastomosis to internal mammary vessels without vein grafts, owing to the long pedicle reach of the chosen flaps. 19 40 In the large case series of 52 patients with more than three reconstructions, Wong et al also recommended the use of flaps with long pedicles, as this allows the pedicle to reach the contralateral neck without the need for a vein graft. 28 In their series, by the third reconstruction, the most commonly used flaps were the ALT, fibula, and the profunda artery perforator flap.…”

Lingual Artery as the Recipient Vessel of Choice in Patients Requiring a Second or Third Free Flap in Recurrent Oral Cancers and Vessel-Depleted Neck: A 5-Year Experience in a Single Institute

“…There are several reports of using recipient vessels outside of the reconstruction zone. The dorsal scapular artery, 10 internal mammary vessels, 11 internal mammary artery perforators, 12 and lateral thoracic artery 13 are far from the damaged zone and are available in reconstruction. However, dissection of these vessels may be extremely time-consuming, prolonging the duration of surgery.…”

Free tissue reconstruction in the “vessel‐depleted” neck: A multi‐institutional cohort study

“…A neck with prior RTND is often avoided by microsurgeons due to the lack of suitable vessels and theoretically increased risk of free flap demise. Much of the literature on the VDN neck is focused on use of contralateral or extracervical vessels outside the field of prior RTND (Chia et al, 2011; Frohwitter et al, 2018; Jacobson et al, 2008; Kushida‐Contreras et al, 2021; Lin et al, 2019; Martinez et al, 2020; Prince et al, 2020; Reddy et al, 2020; Rosko et al, 2017; Schneider et al, 2012; Sudirman et al, 2019; Tessler et al, 2017). In a recent review, the superficial temporal vessels were used most frequently for free tissue transfer in this setting (Kushida‐Contreras et al, 2021; Shimizu et al, 2009; Sudirman et al, 2019; Tan et al, 2014).…”

“…Subcutaneous tunneling of the pedicle is required to reach the superficial temporal vessels, which may result in external compression of the pedicle or kinking. The use of other extracervical vessels such as the dorsal scapular artery, cephalic vein, and internal mammary vessels have also been described (Jacobson et al, 2008; Kushida‐Contreras et al, 2021; Martinez et al, 2020; Prince et al, 2020; Rosko et al, 2017; Schneider et al, 2012). However, their increased distance from the defect site requires a longer pedicle length or vein graft.…”