Use of internal mammary vessels in head and neck microvascular reconstruction

Objective: 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. Design: Retrospective medical record review study. Setting: Oregon Health and Science University and University of Alabama. Patients: Patients for whom IMVs were used for head and neck reconstruction from January 1, 1998, through December 31, 2010. Main Outcome Measures: Intraoperative or postoperative complications, flap survival, and morbidity due to the flap. Results: 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%. Conclusion: Internal mammary vessels provide reliable recipient vessels for cervical and sternal microvascular reconstruction.