Use of a combined latissimus dorsi scapular free flap revascularized with vein grafting to the internal mammary artery in a vessel-depleted and previously irradiated neck

William E. Karle, Sumeet M. Anand, Jason B. Clain, Sophie Scherl, Daniel Buchbinder, Mark L. Smith, Mark L. Urken

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background For patients who have extensive prior treatment, use of the internal mammary artery/vein (IMA/IMV) or cephalic vein has been shown to be a reliable option. Additionally, for those patients who require vascularized bone and extensive soft tissue reconstruction, the combined latissimus dorsi scapular free flap (mega-flap) is an excellent option. Methods We reviewed 3 cases in which extensive prior surgery and radiation precluded the use of traditional recipient vessels in the neck. Results Three patients with major jaw deformities were reconstructed using a mega-flap. In all cases, saphenous vein grafting succeeded in achieving arterial inflow from the IMA to the subscapular artery. Venous egress was achieved using a vein graft to the IMV in 1 patient and a transposed cephalic vein in the remaining 2 patients. Conclusions This approach of restoring large oral cavity defects for patients with extensive prior therapy and comorbid conditions has proven to be reliable and reproducible.

Original languageEnglish
Pages (from-to)E328-E332
JournalHead and Neck
Volume35
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

Keywords

  • internal mammary vessels
  • latissimus dorsi scapular free flap
  • microvascular reconstruction
  • vein graft
  • vessel-depleted neck

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