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Original Article |

Internal Mammary Artery and Vein as Recipient Vessels in Head and Neck Reconstruction

Adam S. Jacobson, MD; Mark Smith, MD; Mark L. Urken, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):623-628. doi:10.1001/jamaoto.2013.3062.
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Importance Free-tissue transfer for head and neck reconstruction has evolved since the mid-1950s. A variety of different recipient arteries and veins have been described for use in head and neck reconstruction. In our experience, the internal mammary artery (IMA) and internal mammary vein (IMV) have become increasingly important for achieving successful microvascular reconstruction.

Objective To illustrate the efficacy of the IMA and IMV recipient vessels in head and neck reconstruction, highlighting the different techniques used to harvest these vessels and outline decision making when approaching a neck where commonly used vessels are unavailable.

Design Retrospective medical record review.

Setting Outpatient clinic setting.

Participants All free-tissue transfers performed between 2005 and 2011. All patients in whom the IMA or IMV recipient vessels were used were included.

Interventions Twelve cases were performed with IMA and IMV harvest.

Main Outcomes and Measures Donor site, flap used, recipient artery and vein, success of transfer, flap survival, and presence of donor site complications.

Results The IMA and IMV were harvested in 12 patients, with 11 successful free-tissue transfers. In 1 patient, the vessels were unusable, and a regional tissue transfer was performed.

Conclusions and Relevance The IMA and IMV are excellent recipient vessels for use in head and neck reconstruction and should be considered for use in challenging reconstructive cases.

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Figure 1. Normal vascular anatomy of the internal mammary artery and vein. (Reprinted with permission from Continuum Health Partners.)

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Figure 2. Zigzag skin incision for access over the right side of the chest. (Reprinted with permission from Continuum Health Partners.)

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Figure 3. Conventional technique for access to the internal mammary (IM) artery and vein. A, Standard technique. Sagittal view of the IM artery and ribs. CC indicates costrochondral cartilage. B, Incision of perichondrium over the rib segment to be removed. C, Incision through deep perichondrium after removal of the rib to enable access to the IM artery and vein. D, Dissection of the intercostal muscles and perforators from underlying IM vessels. (Reprinted with permission from Continuum Health Partners.)

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Figure 4. Conventional technique. Internal mammary artery and vein are rotated superiorly, with vein grafts to the scapular free flap.

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Figure 5. Rib-sparing technique. Pectoralis major muscle fibers are separated to gain access to the intercostal space. (Reprinted with permission from Continuum Health Partners.)

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Figure 6. Rib-sparing technique. A, Incision of perichondrium of the second and third ribs. CC indicates costrochondral cartilage. B, Intercostal musculature and perichondrium have been removed to allow access to the internal mammary (IM) vessels. (Reprinted with permission from Continuum Health Partners.)

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