Purpose of review: Microvascular reconstruction for head and neck cancers has improved both cosmesis and functionality of patients undergoing treatment. Many patients have had prior surgery (neck dissection), radiation and/or chemotherapy as part of their management. When microvascular reconstruction is required after previous treatment, finding appropriate vessels for anastomosis can be difficult. In this paper we explore the options for microvascular reconstruction in the vessel-depleted neck.
Recent findings: Arterial options that exist when the neck is depleted of vessels include the superficial temporal, transverse cervical, thoracoacromial, and the internal mammary artery. Venous options include the cephalic vein and vein grafts.
Summary: The external carotid artery and the internal jugular vein are the most commonly utilized vessels in microvascular reconstruction when available. However, prior chemotherapy and/or radiation can cause significant scarring and damage to these vessels. Also in patients who have had previous surgery, these vessels can be resected or altered in a way that they are deemed unusable. In these situations several vascular options exist outside the neck.