Semin Plast Surg 2010; 24(2): 155-170
DOI: 10.1055/s-0030-1255333
© Thieme Medical Publishers

Anatomic Variations in Head and Neck Reconstruction

Bien-Keem Tan1 , Chin-Ho Wong1 , Hung-Chi Chen2
  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
  • 2E-Da Hospital, I-Shou University, Kaohsiung County, Taiwan
Further Information

Publication History

Publication Date:
21 June 2010 (online)

ABSTRACT

Head and neck reconstruction is a technically challenging procedure. Variations encountered in the recipient vessels and commonly used flaps add to the complexity of surgery. This article reviews the commonly encountered variations in the recipient vessels in the neck with emphasis on alternatives and techniques to circumvent these variations. Flaps commonly used in head and neck reconstruction are also reviewed in detail. Furthermore, safety, potential pitfalls, and technical pearls are highlighted.

REFERENCES

  • 1 Wong C H, Wei F C. Microsurgical free flap in head and neck reconstruction.  Head Neck. 2009;  , (Epub ahead of print)
  • 2 McMinn RMH Last's Anatomy: Regional and Applied. 8th ed. Edinburgh, Scotland; Churchill Livingstone 1990: 327-328
  • 3 Cormack G C, Lamberty B GH. The Arterial Anatomy of Skin Flaps. 2nd ed. Edinburgh, Scotland; Churchill Livingstone 1994
  • 4 Anderson J E. Grant's Atlas of Anatomy. 7th ed. Baltimore, MD; Williams & Wilkins 1978
  • 5 Song R, Gao Y, Song Y, Yu Y, Song Y. The forearm flap.  Clin Plast Surg. 1982;  9 21-26
  • 6 Wong C H, Lin J Y, Wei F C. The bottom-up approach to the suprafascial harvest of the radial forearm flap.  Am J Surg. 2008;  196 e60-e64
  • 7 Mordick T G. Vascular variation of the radial forearm flap: a case report.  J Reconstr Microsurg. 1995;  11 345-346
  • 8 Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo J R. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature.  J Anat. 2001;  199(Pt 5) 547-566
  • 9 Sasaki K, Nozaki M, Aiba H, Isono N. A rare variant of the radial artery: clinical considerations in raising a radial forearm flap.  Br J Plast Surg. 2000;  53 445-447 , [Comment in Br J Plast Surg 2001;54(2):180–181]
  • 10 Fatah M F, Nancarrow J D, Murray D S. Raising the radial artery forearm flap: the superficial ulnar artery “trap”.  Br J Plast Surg. 1985;  38 394-395
  • 11 Lutz B S, Wei F C. Microsurgical workhorse flaps in head and neck reconstruction.  Clin Plast Surg. 2005;  32 421-430, vii
  • 12 Wei F C, Chen H C, Chuang C C, Noordhoff M S. Fibular osteoseptocutaneous flap: anatomic study and clinical application.  Plast Reconstr Surg. 1986;  78 191-200
  • 13 Wei F C, Seah C S, Tsai Y C, Liu S J, Tsai M S. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects.  Plast Reconstr Surg. 1994;  93 294-304; discussion 305–306
  • 14 Lippert H, Pabst R. Arterial Variations in Man: Classification and Frequency. Munich, Germany; JF Bergmann Verlag 1985
  • 15 Morris Jr G C, Beall Jr A C, Berry W B, Feste J, De Bakey M E. Anatomical studies of the distal popliteal artery and its branches.  Surg Forum. 1960;  10 498-502
  • 16 Kim D S, Orron D E, Skillman J J. Surgical significance of popliteal arterial variants. A unified angiographic classification.  Ann Surg. 1989;  210 776-781
  • 17 Mauro M A, Jaques P F, Moore M. The popliteal artery and its branches: embryologic basis of normal and variant anatomy.  AJR Am J Roentgenol. 1988;  150 435-437
  • 18 Senior H D. The development of the arteries of the human lower extremity.  Am J Anat. 1919;  25 55-94
  • 19 Chow L C, Napoli A, Klein M B, Chang J, Rubin G D. Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation.  Radiology. 2005;  237 353-360
  • 20 Lutz B S, Wei F C, Ng S H, Chen I H, Chen S H. Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases.  Plast Reconstr Surg. 1999;  103 121-127
  • 21 Tan B K, Wong C H. An anomalous septocutaneous perforator to the skin paddle of the fibula osteocutaneous flap originating from the posterior tibial artery.  J Plast Reconstr Aesthet Surg. 2009;  62 690-692
  • 22 Jones N F, Monstrey S, Gambier B A. Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation.  Plast Reconstr Surg. 1996;  97 707-716; discussion 717–718
  • 23 Schusterman M A, Reece G P, Miller M J, Harris S. The osteocutaneous free fibula flap: is the skin paddle reliable?.  Plast Reconstr Surg. 1992;  90 787-793; discussion 794–798
  • 24 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg. 1989;  84 71-79
  • 25 Yokoo S, Komori T, Furudoi S, Umeda M, Nomura T, Tahara S. Rare variant of the intrasoleus musculocutaneous perforator: clinical considerations in raising a free peroneal osteocutaneous flap.  J Reconstr Microsurg. 2001;  17 225-228
  • 26 Weber R A, Pederson W C. Skin paddle salvage in the fibula osteocutaneous free flap with secondary skin paddle vascular anastomosis.  J Reconstr Microsurg. 1995;  11 239-241; discussion 242–244
  • 27 Wong C H, Tan B K, Wei F C, Song C. Use of the soleus musculocutaneous perforator for skin paddle salvage of the fibula osteoseptocutaneous flap: anatomical study and clinical confirmation.  Plast Reconstr Surg. 2007;  120 1576-1584
  • 28 Wei F C, Yazar S, Lin C H, Cheng M H, Tsao C K, Chiang Y C. Double free flaps in head and neck reconstruction.  Clin Plast Surg. 2005;  32 303-308, v
  • 29 Wong C H, Ong Y S, Chew K Y, Tan B K, Song C. The fibula osteoseptocutaneous flap incorporating the hemisoleus muscle for complex head and neck defects: anatomical study and clinical applications.  Plast Reconstr Surg. 2009;  124 1956-1964
  • 30 Cheng M H, Saint-Cyr M, Ali R S, Chang K P, Hao S P, Wei F C. Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defects.  Head Neck. 2009;  31 361-370
  • 31 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 149-159
  • 32 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle.  Br J Plast Surg. 1989;  42 260-262
  • 33 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases.  Plast Reconstr Surg. 1998;  102 1517-1523
  • 34 Wei F C, Jain V, Celik N, Chen H C, Chuang D C, Lin C H. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.  Plast Reconstr Surg. 2002;  109 2219-2226; discussion 2227–2230
  • 35 Wong C H, Wei F C, Fu B, Chen Y A, Lin J Y. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery.  Plast Reconstr Surg. 2009;  123 571-577
  • 36 Wong C H, Kao H K, Fu B, Lin J Y. A cautionary point in the harvest of the anterolateral thigh myocutaneous flap.  Ann Plast Surg. 2009;  62 637-639
  • 37 Wong C H, Wei F C. Anterolateral thigh flap.  Head Neck. 2010;  32 529-540
  • 38 Koshima I, Soeda S, Yamasaki M, Kyou J. The free or pedicled anteromedial thigh flap.  Ann Plast Surg. 1988;  21 480-485
  • 39 Michels N A, Siddharth P, Kornblith P L, Parke W W. The variant blood supply to the small and large intestines: its import in regional resections.  J Int Coll Surg. 1963;  39 127-170
  • 40 Kornblith P L, Boley S J, Whitehouse B S. Anatomy of the splanchnic circulation.  Surg Clin North Am. 1992;  72 1-30
  • 41 Abrams H L. Angiography, Vol. 2. 2nd ed. Boston, MA; Little, Brown 1971: 1092-1093
  • 42 Gardner E, Gray D J, O'Rahilly R. Anatomy. 4th ed. Tokyo, Japan; Igaku-Shoin/Saunders 1982: 386-387
  • 43 Cuschieri A, Giles G R, Moossa A R. Essential Surgical Practice. 3rd ed. Oxford, England; Butterworth-Heinemann 1995: 95-96
  • 44 Olding M, Jeng J C. Ischemic tolerance of canine jejunal flaps.  Plast Reconstr Surg. 1994;  94 167-173
  • 45 Tsuchida Y, Aoki N, Fukuda O, Nakano M, Igarashi H. Changes in hemodynamics in jejunal flaps of rabbits due to ischemia, venous congestion, and reperfusion as measured by means of colored microspheres.  Plast Reconstr Surg. 1998;  101 147-154
  • 46 Baek S M, Biller H F, Krespi Y P, Lawson W. The lower trapezius island myocutaneous flap.  Ann Plast Surg. 1980;  5 108-114
  • 47 Tan K C, Tan B K. Extended lower trapezius island myocutaneous flap: a fasciomyocutaneous flap based on the dorsal scapular artery.  Plast Reconstr Surg. 2000;  105 1758-1763
  • 48 Haas F, Weiglein A, Schwarzl F, Scharnagl E. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery.  Plast Reconstr Surg. 2004;  113 1580-1590
  • 49 Angrigiani C, Grilli D, Karanas Y L, Longaker M T, Sharma S. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction.  Plast Reconstr Surg. 2003;  111 67-78
  • 50 Goodwin Jr W J, Rosenberg G J. Venous drainage of the lateral trapezius musculocutaneous island flap.  Arch Otolaryngol. 1982;  108 411-413
  • 51 Rasheed M Z, Tan B K, Tan K C. The extended lower trapezius flap for the reconstruction of shoulder tip defects.  Ann Plast Surg. 2009;  63 184-187

Bien-Keem TanM.B.B.S. F.R.C.S. 

Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital

Outram Road, Singapore 169608

Email: bienkeem@singnet.com.sg