Posterior external jugular vein: a useful alternative recipient vessel in head and neck free flap reconstructions
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CASE REPORT
Posterior external jugular vein: a useful alternative recipient vessel in head and neck free flap reconstructions Ryogo Kuba 1
&
Yusuke Shimizu 1 & Reina Kitabata 1 & Shun Yamazaki 1
Received: 3 July 2019 / Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In a case of radical cancer ablation, the external jugular vein (EJV) and internal jugular vein (IJV) are sometimes inevitably eliminated. We report the utilization of posterior external jugular veins (PEJV) for recipients in head and neck microvascular free flap reconstruction. This is a report of two male patients, who had defects successfully reconstructed using posterior external jugular veins (PEJV) as recipient vessels. Since the IJV, EJVand adjacent veins had been totally excised in both cases, PEJV were utilized as recipient vessels without any complications. The cases pioneer use of PEJVas alternative recipient vessels in head and neck microvascular reconstruction. Level of evdence: Level V, therapeutic study Keywords Posterior external jugular vein . Head and neck reconstruction . Microsurgical anastomosis . Internal jugular vein . External jugular vein
Introduction Microvascular free tissue transfer is a widely preferred and effective approach by an increasing number of surgeons actively involved in head and neck defect, and esthetic and/or functional reconstruction [1–4]. Superficial and deep venous systems, specifically the internal jugular vein (IJV), external jugular vein (EJV), common facial vein, and anterior cervical vein, are commonly used as recipient vessels to re-establish tissue circulation by anastomosing with donor vessels in the free flaps [2, 3]. Chalian et al. recently reported that both IJV and EJV had high overall success rates comparable with other veins; and the IJV was considered the most useful recipient vein in free tissue transfer reconstruction [2]. Ibrahim et al. also suggested that the two veins are equally useful [5]. However, previous records indicated up to a 30% postoperative complication rates with the IJV [ 2, 6–10], and although largely desired in free flap microsurgery, both vessels are occasionally inevitably excised during radical neck * Ryogo Kuba [email protected] 1
Department of Plastic and Reconstructive Surgery, School of Medicine University of Ryukyus Hospital, 207, Uebaru, Nisihara-cho, Okinawa, Japan
dissections. Girkar et al. proposed that when such cases arise, alternative vessels are often mobilized from other parts of the body [3]. However, the mobilization process is quite cumbersome, and increases risk of post-operative complications including thrombosis and flap failure. The option of extending the radial forearm free flap to reach distant recipient sites is useful as well [11, 12]. However, this free flap often presents with esthetic problem at the donor site. Therefore, identification of a more accessible and effective alternative technique is still required. Here, we report two cases in which posterior external jugular veins (PEJV)
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