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Utilization of Anterolateral Thigh Flap and Transverse Cervical Recipient Vessels for Head and Neck Cancer Patients With Former Neck Dissection and Irradiation

A Case Series Study

Lin, Kuan-Wen, MD*; Huang, Tony Chieh-Ting, MD, MSc; Cheng, Hsu-Tang, MD

doi: 10.1097/SAP.0000000000001647
Microsurgery
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SDC

Purpose Free flap reconstruction in head and neck cancer patients with prior tumor resection, neck dissection, and irradiation is clinically challenging. The purpose of this study was to investigate the reliability and outcome of using the anterolateral thigh (ALT) flap and transverse cervical recipient vessels for microvascular reconstruction in patients with depleted vessels in the head and neck region caused by previous surgery and irradiation.

Methods Between January 2015 and December 2017, microsurgical head and neck reconstruction was performed using the ALT flap and transverse cervical artery (TCA) as the recipient vessel in 15 patients who had undergone previous neck dissections and irradiation for cancer treatment. All patients had a “vessel-depleted neck” resulting from severe scarring and radiation fibrosis. Clinical data of each patient were recorded.

Results All ipsilateral TCAs were found to be damage free. Subsequently, free ALT flaps were revascularized using the TCAs. One patient developed venous thrombosis, and another patient developed arterial thrombosis. They were both salvaged within 6 hours postoperatively. No flap failure or mortalities were reported within the 30-day postoperative period. Two patients developed orocutaneous fistula and were further managed with wound care. The mean follow-up time was 11.9 ± 6.0 months (range, 5–23 months). Five patients died during the follow-up period from cancer progression.

Conclusions The use of the free ALT flap and TCA as the recipient vessel provides favorable microsurgical outcomes in patients with depleted recipient vessels in the head and neck region caused by previous neck dissections and radiation therapy.

From the *Department of Surgery, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan;

Division of Plastic and Reconstructive Surgery, Mayo Clinic. Rochester, MN; and

Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan.

Received July 17, 2018, and accepted for publication, after revision August 8, 2018.

K.-W.L. and T.C.-T.H. contributed equally to this work.

Presented at the Annual Meeting of Taiwan Surgical Association; March 17 to 18, 2018; Taipei, Taiwan.

Conflicts of interest and sources of funding: none declared.

Reprints: Hsu-Tang Cheng, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taiwan No. 222, Fuxin Rd, Wufeng District, Taichung City 41354, Taiwan. E-mail: hsutangcheng@gmail.com.

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