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Microvascular Reconstruction After Previous Neck Dissection
Christian Head, MD;
Joel A. Sercarz, MD;
Elliot Abemayor, MD, PhD;
Thomas C. Calcaterra, MD;
Jeffrey D. Rawnsley, MD;
Keith E. Blackwell, MD
Arch Otolaryngol Head Neck Surg. 2002;128:328-331.
Background Microvascular reconstruction of defects in the head and neck is more
challenging in patients who have undergone a previous neck dissection, owing
to prior resection of potential cervical recipient blood vessels used for
free flap perfusion.
Objective To evaluate the reliability and safety of free flap reconstruction in
patients with previous neck dissection.
Patients and Methods Sixty free flaps were performed in 59 patients with a medical history
of neck dissection for head and neck cancer. This included patients undergoing
salvage surgery for recurrent cancer as well as patients undergoing secondary
reconstruction of cancer surgery–related defects. Flap selection included
25 radial forearm flaps, 20 fibula flaps, 7 rectus abdominis flaps, 7 subscapular
system flaps, and 1 iliac crest flap.
Results Recipient vessels were used in the field of previous neck dissection
in approximately half the patients with previous selective neck dissection,
while contralateral recipient vessels were always used in patients with a
history of modified radical or radical neck dissection. Vein grafts were not
necessary in any cases. One arterial anastomosis that was created under excessive
tension required urgent reoperation and revision, but there were no cases
of free flap failure.
Conclusions Free flap reconstruction of the head and neck is highly successful in
patients with a history of neck dissection, despite a relative paucity of
potential cervical recipient blood vessels. Heavy reliance on free flaps with
long vascular pedicles obviated the need to perform vein grafts in the present
series, probably contributing to the absence of free flap failure. Previous
neck dissection should not be considered a contraindication to microvascular
reconstruction of the head and neck.
From the Department of Surgery, Division of Head and Neck Surgery,
the University of California Los Angeles School of Medicine, Los Angeles.
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