The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck

Background:Reconstruction in a vessel-depleted neck is challenging. The success rates can bemarkedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reli-able flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to beexplored. The aim of this report is to present our experience and clinical outcomes using the retro-grade flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflowfor complex head and neck reconstruction in patients with a vessel-depleted neck.Methods:Between July 2010 and June 2016, nine patients with a vessel-depleted neck under-went secondary head and neck reconstruction using the retrograde TCA as recipient vessel formicroanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previousbilateral neck dissections and all, except one, had also received radiotherapy. Indications includedneck contracture release (n53), oral (n51), mandibular (n53) and pharyngoesophageal (n52)reconstruction necessitating free anterolateral thigh (n53) and medial sural artery (n51) perfora-tor flaps, fibula (n53) and ileocolon (n52) flaps respectively.Results:There was 100% flap survival rate with no re-exploration or any partial flap loss. Onecase of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbid-ity during the follow-up period.Conclusions:In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option forcomplex secondary head and neck reconstruction in selected patients.