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Ateriovenous subclavia-shunt for head and neck reconstruction.

Depprich RA, Naujoks CD, Meyer U, Kübler NR, Handschel JG - Head Face Med (2008)

Bottom Line: To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created.Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation.The microvascular reconstructive technique is described in detail.

View Article: PubMed Central - HTML - PubMed

Affiliation: Heinrich-Heine-University Duesseldorf, Department of Cranio- and Maxillofacial Surgery, Moorenstr 5, 40225 Duesseldorf, Germany. depprich@med.uni-duesseldorf.de

ABSTRACT
Reconstruction of the facial hard- and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection and/or radiotherapy may impede common reconstruction methods. Even free flaps may not be used without interposition of a vein graft as recipient vessels are not available as a consequence of radical neck dissection. We describe the reconstruction of the facial hard- and soft tissues with a free parasacpular flap in a patient who had received ablative tumor surgery and radical cervical lymphadenectomy as a treatment regimen for squamous cell carcinoma (SCC). To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created. Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation. The microvascular reconstructive technique is described in detail.

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Sufficient length of the pedicle of the scapular flap (tip of the forceps: middle of the free flaps pedicle, goldclips: anastomotic sites of vessel loop). The microvascular anastomosis can be performed without tension on the vessels.
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Figure 5: Sufficient length of the pedicle of the scapular flap (tip of the forceps: middle of the free flaps pedicle, goldclips: anastomotic sites of vessel loop). The microvascular anastomosis can be performed without tension on the vessels.

Mentions: In a 61-year-old male with a history of alcohol and nicotin abuse but no other serious diseases the initial diagnosis of a SCC of the right anterior floor of the mouth and cervical lymph node metastases (pT3, pN2b, pM0, G2) was made. He underwent former surgery including partial resection of the tongue, the mandible and of the floor of the mouth, radical neck dissection of thr right side, selective lymphadenectomy on the left side, immediate reconstruction of the mandible with a reconstruction plate, and intraoral reconstruction with a pectoralis major flap and irradiation post surgery (60 Gy). As a consequence of woundhealing based on the postoperative radiotherapy a large extraoral soft tissue defect and exposition of the reconstruction plate occurred. In order to reconstruct the soft tissues and to establish conditions for a secondary bony defect reconstruction a vessel reconstruction procedure was performed prior to free flap surgery. The saphena magna vein was taken from the patient's right leg. One end of the vein was anastomosed in an end-to-side fashion to the right subclavia artery and the other end in an end-to-side fashion the to the right subclavia vein thus resulting in an arteriovenous loop (fig. 1, 2, 3, 4). After 10 days of healing microvascular free tissue transfer of a osteomyocutan parascapular flap was perfomed. The vessel loop was divided and an end-to-end anastomosis of the flap artery to the arterious branch of the shunt was performed (fig. 5). The flap's vein was anastomosed to the venous branch accordingly. Healing of the transplant was uneventful. No donor-site deficits occured following parascapular flap harvest. Postoperative radiographic and scintigraphic examination showed successful bridging of the bony defect and successfull integration of the osteomyocutan parascapular flap.


Ateriovenous subclavia-shunt for head and neck reconstruction.

Depprich RA, Naujoks CD, Meyer U, Kübler NR, Handschel JG - Head Face Med (2008)

Sufficient length of the pedicle of the scapular flap (tip of the forceps: middle of the free flaps pedicle, goldclips: anastomotic sites of vessel loop). The microvascular anastomosis can be performed without tension on the vessels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600783&req=5

Figure 5: Sufficient length of the pedicle of the scapular flap (tip of the forceps: middle of the free flaps pedicle, goldclips: anastomotic sites of vessel loop). The microvascular anastomosis can be performed without tension on the vessels.
Mentions: In a 61-year-old male with a history of alcohol and nicotin abuse but no other serious diseases the initial diagnosis of a SCC of the right anterior floor of the mouth and cervical lymph node metastases (pT3, pN2b, pM0, G2) was made. He underwent former surgery including partial resection of the tongue, the mandible and of the floor of the mouth, radical neck dissection of thr right side, selective lymphadenectomy on the left side, immediate reconstruction of the mandible with a reconstruction plate, and intraoral reconstruction with a pectoralis major flap and irradiation post surgery (60 Gy). As a consequence of woundhealing based on the postoperative radiotherapy a large extraoral soft tissue defect and exposition of the reconstruction plate occurred. In order to reconstruct the soft tissues and to establish conditions for a secondary bony defect reconstruction a vessel reconstruction procedure was performed prior to free flap surgery. The saphena magna vein was taken from the patient's right leg. One end of the vein was anastomosed in an end-to-side fashion to the right subclavia artery and the other end in an end-to-side fashion the to the right subclavia vein thus resulting in an arteriovenous loop (fig. 1, 2, 3, 4). After 10 days of healing microvascular free tissue transfer of a osteomyocutan parascapular flap was perfomed. The vessel loop was divided and an end-to-end anastomosis of the flap artery to the arterious branch of the shunt was performed (fig. 5). The flap's vein was anastomosed to the venous branch accordingly. Healing of the transplant was uneventful. No donor-site deficits occured following parascapular flap harvest. Postoperative radiographic and scintigraphic examination showed successful bridging of the bony defect and successfull integration of the osteomyocutan parascapular flap.

Bottom Line: To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created.Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation.The microvascular reconstructive technique is described in detail.

View Article: PubMed Central - HTML - PubMed

Affiliation: Heinrich-Heine-University Duesseldorf, Department of Cranio- and Maxillofacial Surgery, Moorenstr 5, 40225 Duesseldorf, Germany. depprich@med.uni-duesseldorf.de

ABSTRACT
Reconstruction of the facial hard- and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection and/or radiotherapy may impede common reconstruction methods. Even free flaps may not be used without interposition of a vein graft as recipient vessels are not available as a consequence of radical neck dissection. We describe the reconstruction of the facial hard- and soft tissues with a free parasacpular flap in a patient who had received ablative tumor surgery and radical cervical lymphadenectomy as a treatment regimen for squamous cell carcinoma (SCC). To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created. Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation. The microvascular reconstructive technique is described in detail.

Show MeSH
Related in: MedlinePlus