INTRODUCTION: Head and neck reconstruction may be difficult in patients with prior radiation and/or neck dissection. What option is available if local flaps can’t be used or have already failed? This challenge limits the reconstructive plan to performing a microsurgical procedure, although appropriate local recipient vessels may not be available.

METHOD: Twelve patients with frozen neck due to prior radiation underwent microsurgical reconstruction for: pharyngeal fistulae – 9 cases; mandible – 1 case; lower lip – 1 case; and cervical defect from resection of recurrent basal cell carcinoma – 1 case. Eleven of such patients also had prior bilateral neck dissection. Free flaps used were: radial forearm – 8 cases; anterolateral thigh flap – 2 cases; fibula – 1 case; and rectus abdominus – 1 case. The internal mammary artery and vein were used as recipient vessels in eleven cases and the mammary artery and cephalic vein used in one case. It was necessary to elongate the vascular pedicle by means of vein graft in three cases.

RESULTS: One patient died of a massive stroke on the second post-op day. All, but one flap survived. The fibula presented venous thrombosis on the first post-op day. Eight of the nine patients with fistula are now able to eat soft and solid food. One still needs intermittent endoscopic dilation after 2 years.

CONCLUSION: When the cervical vessels can’t or should not be used as recipients for microsurgical head and neck reconstruction, the internal mammary vessels and cephalic vein are considered good alternatives.