The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients

Background: A major challenge in head and neck reconstruction in patients with a "frozen neck" is the limited availability of recipient vessels including the carotid artery system. The aim of the present study was to investigate the suitability of the transverse cervical vessels as recipient vessels for free flap reconstruction in head and neck cancer patients. Methods: Thirty-three sides of necks in 26 patients requiring free flap reconstruction were explored. The presence, location, and size of the transverse cervical vessels were documented. Results: Two arteries (6 percent) and four veins (12 percent) were unavailable. Eight arteries (24 percent) and two veins (6 percent) had a diameter of less than 2 mm, 23 arteries (70 percent) and 18 veins (55 percent) had a diameter of 2 to 3 mm, and nine veins (27 percent) were larger than 3 mm. The contralateral neck was explored because of the lack of suitable ipsilateral vessels in six patients (23 percent). The transverse cervical vessels were unsuitable on both sides in two patients (8 percent). All the available transverse cervical vessels were found to be free of disease. Moderate scarring in the supraclavicular region was present in two cases. All flaps survived without vascular events. Conclusions: The transverse cervical vessels were thus suitable as recipient vessels in 92 percent of patients and should be the first choice in difficult head and neck reconstructions.