Microvascular reconstruction in the vessel depleted neck - A systematic review

Surgical therapy is the gold standard in head and neck cancer treatment, whereas adjuvant radiation and chemotherapy may be indicated in advanced cases. Frequently, neck dissections, former flap anastomoses and irradiated tissue leave a neck depleted of recipient vessels. If further surgery becomes inevitable the surgeon is faced with a heavily pretreated surgical field asking for highly reliable solutions for microsurgical reconstruction. From September 2017 until October 2017, a standardised review on the literature of the databases PubMed, Cochrane Library and Web of Science was performed. The primary research led to 1.614 articles, an evaluation by comprehensive content resulted in 26 suitable articles. Overall, 325 patient cases were included in the study. 112 postsurgical complications were noted (34.5%) and 12 deaths were reported (3.7%). The most common flaps harvested were the anterolateral-thigh flap (n = 85, 25.8%), the radial forearm flap (n = 78, 23.7%) and the flaps from the trunk (n = 31, 9.4%). The arteries most frequently used for anastomosis were the internal mammary artery (n = 81; 28%), the transverse cervical artery (n = 46; 15.9%) and the superficial temporal artery (n = 43; 14.9%). The cephalic vein (n = 84; 25.9%), the internal mammary vein (n = 79; 24.4%) and the superficial temporal vein (n = 50; 15.4%) were the most successfully applied veins.