Assessing the Feasibility and Outcomes of Utilizing the Transverse Cervical Artery as a Recipient Vessel for Microvascular Reconstruction Following Prior Neck Dissection or Radiation in Head and Neck Cancer Patients

評估以橫頸動脈作為之前已接受過頸部淋巴廓清手術或放射治療之頭頸癌重建受區血管之可行性與結果

Tz-Luen Liou(劉子綸) ； Cen-Hung Lin(林岑紘) ； Pao-Jen Kuo(郭寶仁)

《臺灣整形外科醫學會雜誌》 33卷1期 (2024/03) Pp. 26-38

摘要

Background: The need for secondary surgery for recurrent head and neck cancer or second primary tumors is growing. Free flap reconstruction in these patients is challenging due to the most commonly used recipient arteries, the branches of the external carotid artery system, are often damaged by previous neck dissections or radiation therapy. Using the transverse cervical artery as the recipient artery is an alternative option in these situations. Aim and Objectives: We aim to share our experience of using the transverse cervical artery as a recipient artery in difficult head and neck reconstruction. We also describe our technique as different from previous literature to dissect the transverse cervical artery. Materials and Methods: We approached the transverse cervical vessels between the sternal and clavicular head of the sternocleidomastoid muscle. We conducted a retrospective chart review of head and neck free flap reconstructions from June 2019 to December 2020. Our analysis was focused on patient with previous neck dissection or radiation therapy using the transverse cervical artery as the recipient artery. Complications including total flap loss, partial flap loss, chyle leak, phrenic nerve injury, hematoma, and salivary fistula were counted. Results: A total of 18 patients were included. The free flaps used for the reconstruction included the anterolateral thigh flap (n = 13), anteromedial thigh flap (n = 2), posteromedial thigh flap (n = 2), and fibular flap (n = 1). The average length of the transverse cervical artery was 3.4 cm (2.5 to 4.5 cm), and the average size was 2.2 mm (1.8 to 2.5 mm). No phrenic nerve injury, thoracic duct injury, hematoma, or salivary fistula was noted. There were one partial flap necrosis and one total flap failure. The microsurgical complication rate is 11.1%, and the total flap failure rate is 5.6%. Conclusion: The transverse cervical artery is a safe and reliable recipient artery for head and neck reconstruction. And we also demonstrated a different way to dissect the transverse cervical artery, which can provide a lower thoracic duct injury rate, and help us obtain larger diameters, and expose possible recipient veins from the internal jugular vein branches at the same time.

關鍵字

transverse cervical artery ； vessel-depleted neck ； head and neck reconstruction ； microvascular surgery ； frozen neck

並列摘要

背景：臨床上針對頭頸癌復發或第二原發性腫瘤進行二次手術的需求正在增長。這些患者的外頸動脈系統分支，即常用的頭頸癌顯微重建受區動脈，常因先前的頸部淋巴廓清手術或放射治療而受損，使得游離皮瓣重建更具挑戰性。在這些情況下，使用橫頸動脈作為受區動脈則是一種替代選擇。目的及目標：我們希望藉由分享本院在困難頭頸癌重建中使用橫頸動脈作為受區動脈的經驗，同時描述與先前文獻不同的分離橫頸動脈的方式，以提供臨床醫師治療的參考依據。材料及方法：我們從胸鎖乳突肌的胸骨頭和鎖骨頭之間去分離橫頸動脈。本計劃是回顧性病例分析，我們收集2019年6月至2020年12月的接受頭頸癌游離皮瓣重建的病人。我們的分析側重於使用橫頸動脈作為受區動脈，且先前接受過頸部淋巴廓清手術或放射治療的患者。併發症統計包括皮瓣全部壞死、皮瓣局部壞死、乳糜胸、血腫、口腔皮膚瘻管。結果：本試驗案總收錄人數為18人。用於重建的游離皮瓣包括ALT皮瓣（n=13）、AMT皮瓣（n=2）、PMT皮瓣（n=2）和腓骨皮瓣（n=1）。橫頸動脈的平均長度為3.4公分（2.5至4.5公分），平均大小為2.2毫米（1.8至2.5毫米）。未有任何膈神經損傷、乳糜胸、血腫、口腔皮膚瘻管案件發生。皮瓣部分壞死1例，皮瓣完全壞死1例。顯微手術併發症發生率為11.1%，皮瓣失敗率為5.6%。結論：使用橫頸動脈作為困難頭頸癌重建的受體動脈是安全且可靠的。我們也展示了一種不同的方法來分離橫頸動脈，它可以提供較低的胸管損傷率，並幫助我們獲得更大的動脈直徑，也可從同時暴露的內頸靜脈分支找尋可能的受區靜脈。