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  • Title: 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.
    Author: Karle WE, Anand SM, Clain JB, Scherl S, Buchbinder D, Smith ML, Urken ML.
    Journal: Head Neck; 2013 Nov; 35(11):E328-32. PubMed ID: 23152141.
    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.
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