Download PDF
J Reconstr Microsurg 2024; 40(02): 102-108
DOI: 10.1055/a-2086-0146
Original Article

Transverse Cervical Artery for Head and Neck Reconstruction with Free Jejunal Flaps: A Retrospective Study of Computed Tomography Angiography

Kou Fujisawa 
1   Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
,
Shimpei Miyamoto
1   Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
,
Yuki Saito
2   Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
,
Sho Suzuki
1   Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
,
Mutsumi Okazaki
1   Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background The transverse cervical artery is less commonly used than other external carotid arteries as a recipient vessel. Therefore, we aimed to compare the utility of the transverse cervical artery as a recipient vessel with that of the external carotid artery system for microvascular head and neck reconstruction by quantitative analysis of dynamic-enhanced computed tomography.

Methods Fifty-one consecutive patients who underwent free jejunum transfer following total pharyngolaryngectomy between January 2017 and December 2020 were retrospectively reviewed. Ninety-four pairs of the diameters of the transverse cervical artery, superior thyroid artery, and lingual artery, measured via computed tomography angiography, were analyzed. Operative outcomes were compared between the following groups based on the recipient artery: transverse cervical artery (n = 27), superior thyroid artery (n = 17), and other artery (n = 7) groups.

Results In the analysis of the computed tomography angiography, nine transverse cervical arteries (9.6%) could not be identified. However, the percentage was significantly lower than the percentage of superior thyroid arteries (20.2%) and lingual arteries (18.1%) (p < 0.01). Among the identified vessels, the transverse cervical arteries (2.09 ± 0.41 mm) and the lingual arteries (1.97 ± 0.40 mm) were significantly larger than the superior thyroid arteries (1.70 ± 0.36 mm) in diameter at the commonly used level (p < 0.01). Multivariate analysis revealed that prior radiation therapy was not an independent factor significantly affecting transverse cervical artery diameter (p = 0.17). Intraoperative anastomotic revision was required in only two cases of the superior thyroid artery.

Conclusion The transverse cervical artery can offer a larger caliber and more reliable candidate than the superior thyroid artery for a recipient artery. More liberal use of the transverse cervical artery may improve the safety of microsurgical head and neck reconstruction.

Keywords

transverse cervical artery - computed tomography angiography - head and neck reconstruction - recipient vessel - microvascular anastomosis


Publication History

Received: 28 December 2022

Accepted: 02 May 2023

Accepted Manuscript online:
04 May 2023

Article published online:
07 June 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004; 52 (02) 148-155 , discussion 156–157
    CrossrefPubMedGoogle Scholar
  • 2 Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery 2007; 27 (07) 588-594
    CrossrefPubMedGoogle Scholar
  • 3 Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg 2011; 27 (01) 47-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Yagi S, Suyama Y, Fukuoka K, Takeuchi H, Kitano H. Recipient vessel selection in head and neck reconstruction based on the type of neck dissection. Yonago Acta Med 2016; 59 (02) 159-162
    PubMedGoogle Scholar
  • 5 Hiller A, Davis J, Schulz S, Henderson J, Wilhelmi BJ. Recipient vessel selection in head and neck reconstruction. Eplasty 2017; 17: e42
    PubMedGoogle Scholar
  • 6 Chung JH, Kim KJ, Jung KY, Baek SK, Park SH, Yoon ES. Recipient vessel selection for head and neck reconstruction: a 30-year experience in a single institution. Arch Craniofac Surg 2020; 21 (05) 269-275
    CrossrefPubMedGoogle Scholar
  • 7 Xu H, Jazayeri L, Matros E, Henderson PW. Anatomy, exposure, and preparation of recipient vessels in microsurgical head and neck reconstruction. J Reconstr Microsurg 2021; 37 (02) 97-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Mata Ribeiro L, Tsao CK, Hung YL. et al. Venous size discrepancy is a critical factor when using superficial temporal vessels as recipient vessels for free flaps. J Reconstr Microsurg 2022; 38 (08) 654-663
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Tanaka K, Suesada N, Homma T, Mori H, Okazaki M. Reliability of temporal vascular anastomosis and techniques for better outcomes. J Reconstr Microsurg 2022; 38 (01) 41-46
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Venkatesh V, Fracol M, Turin S, Ellis M, Alghoul M. Utilization of intraparotid segments of superficial temporal vessels for head and scalp free flap microanastomosis: a clinical, histological, and cadaveric study. J Reconstr Microsurg 2020; 36 (04) 253-260
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Ozgur Z, Govsa F, Celik S, Ozgur T. Clinically relevant variations of the superior thyroid artery: an anatomic guide for surgical neck dissection. Surg Radiol Anat 2009; 31 (03) 151-159
    CrossrefPubMedGoogle Scholar
  • 12 Neligan PC, She-Yue H, Gullane PJ. Reverse flow as an option in microvascular recipient anastomoses. Plast Reconstr Surg 1997; 100 (07) 1780-1785 , discussion 1786–1787
    CrossrefPubMedGoogle Scholar
  • 13 Chen YC, Scaglioni MF, Huang EY, Kuo YR. Utility of “open-Y” anastomosis technique in the use of superior thyroid artery as recipient vessel for head and neck reconstruction with free flap. Microsurgery 2016; 36 (05) 391-396
    CrossrefPubMedGoogle Scholar
  • 14 Monsivais JJ. Microvascular grafts: effect of diameter discrepancy on patency rates. Microsurgery 1990; 11 (04) 285-287
    CrossrefPubMedGoogle Scholar
  • 15 López-Monjardin H, de la Peña-Salcedo JA. Techniques for management of size discrepancies in microvascular anastomosis. Microsurgery 2000; 20 (04) 162-166
    CrossrefPubMedGoogle Scholar
  • 16 Akan M, Çakir B, Aköz T. “Open y” technique in vessel diameter discrepancy. Microsurgery 2006; 26 (07) 506-514
    CrossrefPubMedGoogle Scholar
  • 17 Tessler O, Gilardino MS, Bartow MJ. et al. Transverse cervical artery: consistent anatomical landmarks and clinical experience with its use as a recipient artery in complex head and neck reconstruction. Plast Reconstr Surg 2017; 139 (03) 745e-751e
    CrossrefPubMedGoogle Scholar
  • 18 Yu P. The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients. Plast Reconstr Surg 2005; 115 (05) 1253-1258
    CrossrefPubMedGoogle Scholar
  • 19 Xu ZF, Duan WY, Zhang EJ. et al. Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy. World J Surg Oncol 2015; 13: 183
    CrossrefPubMedGoogle Scholar
  • 20 Prisman E, Baxter P, Genden EM. Revisiting the transverse cervical artery and vein for complex head and neck reconstruction. Journal of Reconstructive Microsurgery Open 2019; 04: e54-e57
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Sarukawa S, Sakuraba M, Kimata Y. et al. Standardization of free jejunum transfer after total pharyngolaryngoesophagectomy. Laryngoscope 2006; 116 (06) 976-981
    CrossrefPubMedGoogle Scholar
  • 22 Miyamoto S, Nakao J, Higashino T, Yoshimoto S, Hayashi R, Sakuraba M. Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer. PLoS One 2019; 14 (09) e0222570
    CrossrefPubMedGoogle Scholar
  • 23 Conley D, Hurst PR, Stringer MD. An investigation of human jejunal and ileal arteries. Anat Sci Int 2010; 85 (01) 23-30
    CrossrefPubMedGoogle Scholar
  • 24 Lee JW, Son JW, Go TH. et al. Reference diameter and characteristics of the distal radial artery based on ultrasonographic assessment. Korean J Intern Med (Korean Assoc Intern Med) 2022; 37 (01) 109-118
    PubMedGoogle Scholar
  • 25 Boucher F, Brosset S, Shipkov H. et al. An anatomic study of deep inferior epigastric artery diameters at the origin from external iliac and at the lateral border of rectus abdominis muscle by computed tomographic angiography from autologous breast reconstruction patients. Ann Chir Plast Esthet 2020; 65 (01) 70-76
    CrossrefPubMedGoogle Scholar
  • 26 Cobiella R, Quinones S, Konschake M. et al. The carotid axis revisited. Sci Rep 2021; 11 (01) 13847
    CrossrefPubMedGoogle Scholar
  • 27 Nicolau LG, Martins WP, Gallarreta FM, Lima JC, Filho FM. Influence of pregnancy and smoking on brachial artery flow-mediated dilation values and time until maximum response. Arch Gynecol Obstet 2011; 284 (02) 313-317
    CrossrefPubMedGoogle Scholar
  • 28 Kweon SS, Lee YH, Shin MH. et al. Effects of cumulative smoking exposure and duration of smoking cessation on carotid artery structure. Circ J 2012; 76 (08) 2041-2047
    CrossrefPubMedGoogle Scholar
  • 29 Zhu BQ, Parmley WW. Hemodynamic and vascular effects of active and passive smoking. Am Heart J 1995; 130 (06) 1270-1275
    CrossrefPubMedGoogle Scholar
  • 30 Labropoulos N, Zarge J, Mansour MA, Kang SS, Baker WH. Compensatory arterial enlargement is a common pathobiologic response in early atherosclerosis. Am J Surg 1998; 176 (02) 140-143
    CrossrefPubMedGoogle Scholar