Skip to main content

Advertisement

SpringerLink
Log in

Head and Neck Reconstruction of the Vessel-Depleted Neck: A Systematic Review of the Literature

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Damage of the vascular system secondary to radical neck dissection and/or radiotherapy or other treatments has a negative impact on microsurgical reconstruction. The search for adequate recipient vessels is hindered by the complexity of previous procedures.

Methods

A systematic review of microsurgical head and neck reconstruction in the vessel-depleted neck was performed. The issues analyzed were indications for surgery, more frequently performed flaps, vascular systems used as recipient vessels, outcomes, and complications.

Results

The eligibility criteria were fulfilled by 57 studies published between September 1993 and January 2020. In 8235 patients, 8694 flaps were performed, 925 of which were for a vessel-depleted neck. The most commonly used flap was the anterolateral thigh flap, used in 195 cases (30%), followed by the radial forearm free flap, used in 157 cases (24%). The potential recipient vessels were numerous for arteries (26 options) and veins (31 options). For the 712 flaps with an identifiable recipient artery, the superficial temporal artery was the most commonly used vessel (n = 142, 20%). The superficial temporal vein was the most commonly used vessel for 639 flaps with an identifiable recipient vein (n = 118, 18.5%). Complications amounted to 11%; 80 out of 716 flaps in papers that reported them. Flap losses were reported in 2% of cases.

Conclusions

Major microsurgical head and neck reconstruction for postoncologic defects depends on appropriate recipient vessels. Vein availability is paramount. Understanding the complexity of this problem is useful for preoperative planning, precise decision-making, and an accurate surgical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ho AL, Lyonel Carre A, Patel KM. Oncologic reconstruction: general principles and techniques. J Surg Oncol. 2016;113:852–64.

    Article  PubMed  Google Scholar 

  2. Abouyared M, Katz AP, Ein L, Ketner J, Sargi Z, Nicolli E, et al. Controversies in free tissue transfer for head and neck cancer: a review of the literature. Head Neck. 2019;41:3457–63.

    Article  PubMed  Google Scholar 

  3. Ibrahim ASG, Kakarala K, Bur AM. Lateral thoracic artery as recipient vessel for head and neck free flap reconstruction in the vessel depleted neck: a case report. Microsurgery. 2019;39:748–52.

    Article  PubMed  Google Scholar 

  4. Mulholland S, Boyd JB, McCabe S, Gullane P, Rotstein L, Brown D, et al. Recipient vessels in head and neck microsurgery. Plast Reconstr Surg. 1993;92(4):628–32.

    Article  CAS  PubMed  Google Scholar 

  5. Kadota H, Fukushima J, Yoshida S, Kamizono K, Kumamoto Y, Masuda M, et al. Microsurgical free flap transfer in previously irradiated and operated necks: feasibility and safety. Auris Nasus Larynx. 2012;39:496–501.

    Article  PubMed  Google Scholar 

  6. Reddy T, Sham E, Ganesh M, Menon PS, Gowda K, Malick R. Feasibility and reliability of microvascular reconstruction in the vessel-depleted previously operated neck. Ann Maxillofac Surg. 2020;10:96.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HF. Geometry of the vascular pedicle in free tissue transfers to the head and neck. Arch Otolaryngol Neck Surg. 1989;115:954–60.

    Article  CAS  Google Scholar 

  8. Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg. 2011;27:47–55.

    Article  PubMed  Google Scholar 

  9. Head C, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Blackwell KE. Microvascular reconstruction after previous neck dissection. Arch Otolaryngol Head Neck Surg. 2002;128:328–31.

    Article  PubMed  Google Scholar 

  10. Tan NC, Lin PY, Chiang YC, Chew KY, Chen CC, Fujiwara T, et al. Influence of neck dissection and preoperative irradiation on microvascular head and neck reconstruction: analysis of 853 cases. Microsurgery. 2014;34:602–7.

    Article  PubMed  Google Scholar 

  11. Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA. Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg. 1984;74:217–26.

    Article  CAS  PubMed  Google Scholar 

  12. Tavassol F, Kokemüller H, Zimmerer R, Gellrich NC, Eckardt A. Effect of neoadjuvant chemoradiation and postoperative radiotherapy on expression of heat shock protein 70 (HSP70) in head and neck vessels. Radiat Oncol. 2011;6:1–8.

    Article  Google Scholar 

  13. Huang SH, Wu SH, Wang WH, Cheen MC, Lai CS, Lin SD, et al. Reversed-flow superior thyroid artery: an alternative recipient vessel in head and neck reconstruction. Kaohsiung J Med Sci. 2008;24:598–601.

    Article  PubMed  Google Scholar 

  14. Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: techniques for achieving microvascular reconstruction. Head Neck. 2008;30:201–7.

    Article  PubMed  Google Scholar 

  15. Mahendru S, Singh H, Sarin D, Aggarwal A, Brajesh V, Singh S, et al. Microvascular free tissue transfer in vessel-compromised neck: techniques and recommendations. Int Microsurg J. 2019;3:2–6.

    Article  Google Scholar 

  16. Tsao CK, Loh CYY, Barrera JM. Free tissue transfer as a vascular source for the vessel-depleted neck. Head Neck. 2016;38:E2515–8.

    Article  PubMed  Google Scholar 

  17. Tessler O, Gilardino MS, Bartow MJ, St Hilaire H, Womac D, Dionisopoulos T, et al. Transverse cervical artery: consistent anatomical landmarks and clinical experience with its use as a recipient artery in complex head and neck reconstruction. Plast Reconstr Surg. 2017;139:745e-e751.

    Article  CAS  PubMed  Google Scholar 

  18. Sudirman SR, Shih HS, Chen JCJ, Feng KM, Jeng SF. Superficial temporal vessels, both anterograde and retrograde limbs, are viable recipient vessels for recurrent head and neck reconstruction in patients with frozen neck. Head Neck. 2019;41:3618–23.

    Article  PubMed  Google Scholar 

  19. Hanasono MM, Corbitt CA, Yu P, Skoracki RJ. Success of sequential free flaps in head and neck reconstruction. J Plast Reconstr Aesthetic Surg. 2014;67:1186–93.

    Article  Google Scholar 

  20. Kovatch KJ, Hanks JE, Stevens JR, Stucken CL. Current practices in microvascular reconstruction in otolaryngology: head and neck surgery. Laryngoscope. 2019;129:138–45.

    Article  PubMed  Google Scholar 

  21. Mannelli G, Gazzini L, Comini LV, Parrinello G, Nocini R, Marchioni D, et al. Double free flaps in oral cavity and oropharynx reconstruction: systematic review, indications and limits. Oral Oncol. 2020;104:104637.

    Article  PubMed  Google Scholar 

  22. Horng SY, Chen MT. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction. Plast Reconstr Surg. 1993;92:752–3.

    Article  CAS  PubMed  Google Scholar 

  23. Dolan R, Gooey J, Cho YJ, Fuleihan N. Microvascular access in the multiply operated neck: thoracodorsal transposition. Laryngoscope. 1996;106:1436–7.

    Article  CAS  PubMed  Google Scholar 

  24. Takamatsu A, Harashina T, Inoue T. Selection of appropriate recipient vessels in difficult, microsurgical head and neck reconstruction. J Reconstr Microsurg. 1996;12:499–513.

    Article  CAS  PubMed  Google Scholar 

  25. Kim KA, Chandrasekhar BS. Cephalic vein in salvage microsurgical reconstruction in the head and neck. Br J Plast Surg. 1998;51:2–7.

    Article  CAS  PubMed  Google Scholar 

  26. Nakayama B, Kamei Y, Toriyama K, Hyodo I, Hasegawa Y, Torii S. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck. Plast Reconstr Surg. 2002;109:1246–53.

    Article  PubMed  Google Scholar 

  27. Harris JR, Lueg E, Genden E, Urken ML. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002;128:319–23.

    Article  PubMed  Google Scholar 

  28. Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg. 2004;52:148–55.

    Article  PubMed  Google Scholar 

  29. Ad-El DD, Sichel JE. Reversed-flow external jugular vein: an optional recipient vessel in microsurgical head and neck reconstruction. Plast Reconstr Surg. 2004;113:1873–5.

    Article  PubMed  Google Scholar 

  30. Yazar S, Wei FC, Chen HC, Cheng MH, Huang WC, Lin CH, et al. Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects. Plast Reconstr Surg. 2005;115:1553–61.

    Article  CAS  PubMed  Google Scholar 

  31. Varvares MA, Lin D, Hadlock T, Azzizadeh B, Gliklich R, Rounds M, et al. Success of multiple, sequential, free tissue transfers to the head and neck. Laryngoscope. 2005;115:101–4.

    Article  PubMed  Google Scholar 

  32. Davison SP, Kaplan KA. The deep temporal vein: an alternative recipient vessel in microsurgical head and neck reconstruction. Plast Reconstr Surg. 2005;116:1181–2.

    Article  CAS  PubMed  Google Scholar 

  33. Yu P. The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients. Plast Reconstr Surg. 2005;115:1253–8.

    Article  CAS  PubMed  Google Scholar 

  34. Urken ML, Higgins KM, Lee B, Vickery C. Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck. Head Neck. 2006;28:797–801.

    Article  PubMed  Google Scholar 

  35. Okazaki M, Asato H, Sarukawa S, Takushima A, Nakatsuka T, Harii K. Availability of end-to-side arterial anastomosis to the external carotid artery using short-thread double-needle microsuture in free-flap transfer for head and neck reconstruction. Ann Plast Surg. 2006;56:171–5.

    Article  CAS  PubMed  Google Scholar 

  36. Chang KP, Lee HC, Lai CS, Lin SD. Use of single saphenous interposition vein graft for primary arterial circuit and secondary recipient site in head and neck reconstruction: a case report. Head Neck. 2007;29:412–5.

    Article  PubMed  Google Scholar 

  37. Lin PY, Kuo YR, Chien CY, Jeng SF. Reconstruction of head and neck cancer with double flaps: comparison of single and double recipient vessels. J Reconstr Microsurg. 2009;25:191–6.

    Article  CAS  PubMed  Google Scholar 

  38. Vasilakis V, Patel HDL, Chen H-C. Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck. Microsurgery. 2009;29:598–602.

    Article  PubMed  Google Scholar 

  39. Shimizu F, Lin MP, Ellabban M, Evans GRD, Cheng MH. Superficial temporal vessels as a reserve recipient site for microvascular head and neck reconstruction in vessel-depleted neck. Ann Plast Surg. 2009;62:134–8.

    Article  CAS  PubMed  Google Scholar 

  40. Hölzle F, Hohlweg-Majert B, Kesting MR, Mücke T, Loeffelbein DJ, Wolff KD, et al. Reverse flow facial artery as recipient vessel for perforator flaps. Microsurgery. 2009;29:437–42.

    Article  PubMed  Google Scholar 

  41. Alam DS, Khariwala SS. Technical considerations in patients requiring a second microvascular free flap in the head and neck. Arch Otolaryngol Head Neck Surg. 2009;135:268–73.

    Article  PubMed  Google Scholar 

  42. Alam DS, Nuara M, Christian J. Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis. Otolaryngol Head Neck Surg. 2009;141:196–201.

    Article  PubMed  Google Scholar 

  43. Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery. 2009;29:1–7.

    Article  PubMed  Google Scholar 

  44. Salgarello M, Snider F, Finocchi V, Bussu F, Paludetti G, Almadori G. The Pruitt-Inahara carotid shunt as an assisting tool to anastomose the arterial free flap pedicle to the internal carotid artery in the vessel-depleted neck. Microsurgery. 2011;31:234–6.

    Article  PubMed  Google Scholar 

  45. Quilichini J, Benjoar M-D, Hivelin M, Brugel L, Lantieri L. Semi-free radial forearm flap for head and neck reconstruction in vessel-depleted neck after radiotherapy or radical neck dissection. Microsurgery. 2012;32:269–74.

    Article  PubMed  Google Scholar 

  46. Roche NA, Houtmeyers P, Vermeersch HF, Stillaert FB, Blondeel PN. The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction. J Plast Reconstr Aesthetic Surg. 2012;65:885–92.

    Article  CAS  Google Scholar 

  47. Schneider DS, McClain L, Robb PK, Rosenthal EL, Wax MK. Use of internal mammary vessels in head and neck microvascular reconstruction. Arch Otolaryngol Head Neck Surg. 2012;138:172–6.

    Article  PubMed  Google Scholar 

  48. Kekatpure VD, Trivedi NP, Manjula BV, Mathan Mohan A, Shetkar G, Kuriakose MA. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg. 2012;41:453–7.

    Article  CAS  PubMed  Google Scholar 

  49. Su T, Pirgousis P, Fernandes R. Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks. J Oral Maxillofac Surg. 2013;71:622–7.

    Article  PubMed  Google Scholar 

  50. Karle WE, Anand SM, Clain JB, Scherl S, Buchbinder D, Smith ML, et al. Use of a combined latissimus dorsi scapular free flap revascularized with vein grafting to the internal mammary artery in a vessel-depleted and previously irradiated neck. Head Neck. 2013;35:E328–32.

    Article  PubMed  Google Scholar 

  51. Tamplen M, Blackwell K, Jahan R, Nabili V. Salvage of free-flaps in vessel-depleted mandibular osteoradionecrosis cases using catheter-directed thrombolysis and angioplasty. J Reconstr Microsurg. 2013;29:347–52.

    Article  PubMed  Google Scholar 

  52. Shih HS, Hsieh CH, Feng GM, Feng WJ, Jeng SF. An alternative option to overcome difficult venous return in head and neck free flap reconstruction. J Plast Reconstr Aesthetic Surg. 2013;66:1243–7.

    Article  Google Scholar 

  53. Baj A, Bolzoni A, Torretta S, Pignataro L. Arterial microanastomoses on the reverse flow of the internal carotid artery reverse flow: an extreme solution in free-flap revascularisation. How we do it. Acta Otorhinolaryngol Ital. 2014;34:368–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Xu Z, Duan W, Zhang E, Bai S, Tian Y, Tan X, et al. Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy. World J Surg Oncol. 2015;13:1–6.

    Article  Google Scholar 

  55. Wolff KD, Mücke T, Von Bomhard A, Ritschl LM, Schneider J, Humbs M, et al. Free flap transplantation using an extracorporeal perfusion device: first three cases. J Cranio-Maxillofacial Surg. 2016;44:148–54.

    Article  Google Scholar 

  56. Garg RK, Poore SO, Wieland AM, Sanchez R, Baskaya MK, Hartig GK. Recipient vessel selection in the difficult neck: outcomes of external carotid artery transposition and end-to-end microvascular anastomosis. Microsurgery. 2017;37:96–100.

    Article  PubMed  Google Scholar 

  57. Barreiro GC, Snider CC, Galvão FHF, Baptista RR, Kasai KE, Dos Anjos DM, et al. A new pedicled internal mammary osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction: anatomic study and clinical application. Sci Rep. 2017;7:1–10.

    Article  CAS  Google Scholar 

  58. Rosko AJ, Ryan JT, Wizauer EJ, Ibrahim M, Srinivasan A, Stucken CL, et al. Dorsal scapular artery as a recipient vessel in the vessel-depleted neck during free tissue transfer in head and neck reconstruction. Head Neck. 2017;39:E72–6.

    Article  PubMed  Google Scholar 

  59. Ciudad P, Agko M, Manrique OJ, Date S, Kiranantawat K, Chang WL, et al. The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck. Microsurgery. 2017;37:902–9.

    Article  PubMed  Google Scholar 

  60. Wolff KD. New aspects in free flap surgery: mini-perforator flaps and extracorporeal flap perfusion. J Stomatol Oral Maxillofac Surg. 2017;118:238–41.

    Article  PubMed  Google Scholar 

  61. Ho MW, Brown JS, Shaw RJ. Refining the indications for scapula tip in mandibular reconstruction. Int J Oral Maxillofac Surg. 2017;46:712–5.

    Article  CAS  PubMed  Google Scholar 

  62. Kang SY, Spector ME, Chepeha DB. Perforator-based rectus free tissue transfer for head and neck reconstruction: new reconstructive advantages from an old friend. Oral Oncol. 2017;74:163–70.

    Article  PubMed  Google Scholar 

  63. Ciudad P, Agko M, Date S, Chang WL, Manrique OJ, Huang TCT, et al. The radial forearm free flap as a “vascular bridge” for secondary microsurgical head and neck reconstruction in a vessel-depleted neck. Microsurgery. 2018;38:651–8.

    Article  PubMed  Google Scholar 

  64. Li J, Shen Y, Wang L, Wang J, Sun J, Haugen TW. Superficial temporal versus cervical recipient vessels in maxillary and midface free vascularized tissue reconstruction: our 14-year experience. J Oral Maxillofac Surg. 2018;76:1786–93.

    Article  PubMed  Google Scholar 

  65. Lin KW, Huang TCT, Cheng HT. Utilization of anterolateral thigh flap and transverse cervical recipient vessels for head and neck cancer patients with former neck dissection and irradiation. Ann Plast Surg. 2019;82:415–9.

    Article  CAS  PubMed  Google Scholar 

  66. Javadian R, Bouland C, Rodriguez A, Loeb I, Dequanter D. Head and neck reconstruction: the supraclavicular flap: technical note. Ann Chir Plast Esthet. 2019;64:374–9.

    Article  CAS  PubMed  Google Scholar 

  67. Wolff KD, Ritschl LM, von Bomhard A, Braun C, Wolff C, Fichter AM. In vivo perfusion of free skin flaps using extracorporeal membrane oxygenation. J Cranio-Maxillofac Surg. 2020;48:90–7.

    Article  Google Scholar 

  68. Abu-Zidan FM, Abbas AK, Hefny AF. Clinical “case series”: a concept analysis. Afr Health Sci. 2012;12:557–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction: GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94.

    Article  PubMed  Google Scholar 

  70. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42:645–8.

    Article  CAS  PubMed  Google Scholar 

  71. Tam S, Weber RS, Liu J, Ting J, Hanson S, Lewis CM. Evaluating unplanned returns to the operating room in head and neck free flap patients. Ann Surg Oncol. 2020;27:440–8.

    Article  PubMed  Google Scholar 

  72. Cash H, Abouyared M, Houlton JJ. Optimizing value in head and neck cancer free flap surgery. Curr Opin Otolaryngol Head Neck Surg. 2019;27:413–9.

    Article  PubMed  Google Scholar 

  73. Sweeny L, Rosenthal EL, Light T, Grayson J, Petrisor D, Troob SH, et al. Outcomes and cost implications of microvascular reconstructions of the head and neck. Head Neck. 2019;41:930–9.

    Article  PubMed  Google Scholar 

  74. Goel AN, Raghavan G, St John MA, Long JL. Risk factors, causes, and costs of hospital readmission after head and neck cancer surgery reconstruction. JAMA Facial Plast Surg. 2019;21:137–45.

    Article  PubMed  Google Scholar 

  75. Vamadeva SV, Henry FP, Mace A, Clarke PM, Wood SH, Jallali N. Secondary free tissue transfer in head and neck reconstruction. J Plast Reconstr Aesthetic Surg. 2019;72:1129–34.

    Article  Google Scholar 

  76. Yagi S, Suyama Y, Fukuoka K, Takeuchi H, Kitano H. Recipient vessel selection in head and neck reconstruction based on the type of neck dissection. Yonago Acta Med. 2016;59:159–62.

    PubMed  PubMed Central  Google Scholar 

  77. Moubayed SP, Giot JP, Odobescu A, Guertin L, Harris PG, Danino MA. Arteriovenous fistulas for microvascular head and neck reconstruction. Can J Plast Surg. 2015;23:167–70.

    Article  Google Scholar 

  78. Frohwitter G, Rau A, Kesting MR, Fichter A. Microvascular reconstruction in the vessel depleted neck: a systematic review. J Cranio-Maxillofac Surg. 2018;46:1652–8.

    Article  Google Scholar 

  79. Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128:305–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Sugrue CM, Joyce CW, Carroll SM. Levels of evidence in plastic and reconstructive surgery research. Plast Reconstr Surg Glob Open. 2019;7:e2408.

    PubMed  PubMed Central  Google Scholar 

  81. Ibrahim AE, Adelman DM, Parham C, Hong Z, Villa M, Chahine FM, et al. The external jugular vein used as recipient vessel in head and neck free flap reconstruction: outcomes compared to the internal jugular vein. J Craniofac Surg. 2019;30:178–83.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Department, Mexico’s General Hospital (Hospital General de México), Mexico City, Mexico

    Beatriz Hatsue Kushida-Contreras MD

  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, NY, USA

    Oscar J. Manrique MD

  3. Plastic and Reconstructive Surgery Department, Mexico’s Children Hospital (Hospital Infantil de México “Federico Gómez”), Mexico City, Mexico

    Miguel Angel Gaxiola-García MD, MSc

Authors
  1. Beatriz Hatsue Kushida-Contreras MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oscar J. Manrique MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Angel Gaxiola-García MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miguel Angel Gaxiola-García MD, MSc.

Ethics declarations

Disclosure

Beatriz Hatsue Kushida-Contreras, Oscar J. Manrique, and Miguel Angel Gaxiola-García have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kushida-Contreras, B.H., Manrique, O.J. & Gaxiola-García, M.A. Head and Neck Reconstruction of the Vessel-Depleted Neck: A Systematic Review of the Literature. Ann Surg Oncol 28, 2882–2895 (2021). https://doi.org/10.1245/s10434-021-09590-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-09590-y

Search

Navigation