The thoracoacromial trunk: Alternative recipient vessels in reoperative head and neck reconstructive microsurgery

Background: Reoperative free tissue transfer in head and neck cancer patients is often a challenging endeavor. Finding adequate recipient vessels for microvascular anastomosis can be difficult, as scar is present from previous surgery and irradiation, and the usual recipient vessels may have been damaged or sacrificed. Methods: Seventeen consecutive cases of head and neck reconstruction with free tissue transfer using the thoracoacromial vessels as the recipient pedicle were reviewed. Clinical data were analyzed, including indication for surgery, preoperative radiation dose, previous pectoralis major myofascial flap, free flap design, operative technique, perioperative complications, and follow-up. Results: Of the 17 cases of free tissue transfer using thoracoacromial vessels for anastomosis, 13 flaps were performed in 12 patients who had received double irradiation. Twelve thoracoacromial trunks used as recipient vessels were in patients with transferred pectoral myofascial flaps. Anastomotic patency was achieved in all flaps. Conclusions: The thoracoacromial trunk is a good alternative for recipient vessels in reoperative reconstructive microsurgery of the head and neck when first-line vessels are not available. This choice of vessels is feasible whether or not a pectoralis myofascial flap has previously been used.