Use of internal mammary vessels in head and neck microvascular reconstruction

To describe the use of the internal mammary vessels (IMVs) in microvascular head and neck reconstruction in a small case series with select donor sites.

Retrospective medical record review study.

Oregon Health and Science University and University of Alabama.

Patients for whom IMVs were used for head and neck reconstruction from January 1, 1998, through December 31, 2010.

Intraoperative or postoperative complications, flap survival, and morbidity due to the flap.

Of 2721 free tissue transfers, 55 (2%) (in 48 patients) used IMVs. Use of IMVs was associated with ablative surgery with sternal resection (25 of 55 [45%]), a vessel depleted neck (23 of 55 [42%]), and fistula repair with gross contamination due to prior flap failure or chronic pharyngocutaneous fistula with vessel depleted neck (7 of 55 [13%]). Flaps included radial forearm (33 of 55 [60%]), jejunum (9 of 55 [16]), ulnar (5 of 55 [9%]), and other (8 of 55 [14%]). No vein grafts were used. Pneumothorax developed in 1 patient (2%). Postoperative fistulas were observed in 14 of 48 patients (29%); the fistulas healed conservatively in 7 patients (50%), rotation of flap tissue was required in 2 patients (14%), and the fistulas persisted in 5 patients (36%). The flap survival rate was 98%.

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