Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-30T06:40:30.699Z Has data issue: false hasContentIssue false

Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage

Published online by Cambridge University Press:  29 June 2007

C. R. Leemans
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, The Netherlands. Head and neck oncology fellow of the Dutch Cancer Society (NKB/KWF).
A. J. M. Balm*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, The Netherlands.
R. T. Gregor
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, The Netherlands.
F. J. M. Hilgers
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, The Netherlands.
*
A. J. M. Balm, M.D., The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands

Abstract

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ariyan, S. (1979) The pectoralis major myocutaneous flap. Plastic and Reconstructive Surgery 63: 7381.CrossRefGoogle ScholarPubMed
Ariyan, S., Cuono, C. B. (1980) Use of the pectoralis major myocutaneous flap for reconstruction of large cervical, facial or cranial defects. American Journal of Surgery 140: 503506.CrossRefGoogle Scholar
Baek, S. E., Biller, H. F., Krespi, Y. P., Lawson, W. (1979) The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head and Neck Surgery 1: 293300.CrossRefGoogle ScholarPubMed
Balm, A. J. M., Hilgers, F. J. M., Bans, G., Keus, R. B. (1993) Pectoralis major muscle transposition: an adjunct to laryngeal preservation in severe chondroradionecrosis. Journal of Laryngology and Otology 107: 748751.CrossRefGoogle ScholarPubMed
Bos, K. E., Balm, A. J. M., Schouwenburg, P. E., Hilgers, F. J. M., Boer de, J. B. (1991) Free muscle transfer with split thickness skin graft coverage in head and neck reconstruction. European Journal of Surgical Oncology 17: 323329.Google Scholar
Cheek, H. B., Rise, E. N. (1967) Carotid artery protection and a new technique. Archives of Otolaryngology 86: 179182.CrossRefGoogle ScholarPubMed
Coleman, J. J. (1985) Treatment of the ruptured or exposed carotid artery. Southern Medical Journal 78: 262.CrossRefGoogle ScholarPubMed
Conley, J. J. (1953) The prevention of carotid artery hemorrhage by the use of rotating tissue flaps. Surgery 34: 186194.Google ScholarPubMed
Conley, J. J. (1962) Carotid artery protection. Archives of Otolaryngology 75: 6065.Google ScholarPubMed
Conley, J. J., Baker, D. C. (1979) Catastrophic necrosis of the neck. Otolaryngology—Head and Neck Surgery 87: 610613.CrossRefGoogle ScholarPubMed
Corso, P. F., Gerold, F. P. (1963) Use of autogenous dermis for protection of the carotid artery and pharyngeal suture lines in radical head and neck surgery. Surgery Gynecology Obstetrics 17: 3740.Google Scholar
Gardiner, L. J., Aniyan, S., Pillsbury, H. C. (1983) Myocutaneous flaps for challenging problems in head and neck reconstruction. Archives of Otolaryngology 109: 396399.CrossRefGoogle ScholarPubMed
Goldstein, R. D., Komisar, A., Silver, C., Strauch, B. (1988) Management of necrotic neck wounds with a “sandwich” pectoralis myocutaneous flaps. Head and Neck Surgery 10: 246251.CrossRefGoogle Scholar
Hanel, D. P. (1989) Vasculanized tissue transfer. An adjunct to the treatment of osteomyelitis. Orthopedic Reviews 18: 595608.Google Scholar
Joseph, C. A., Fayman, M. S., Kadwa, M. A., Gregor, R. T. (1988) The pectoralis major flap for reconstruction of septic wounds. South African Journal of Surgery 26: 107109.Google ScholarPubMed
Moloy, P. J. (1989) Reconstruction of intermediate sized mucosal defects with the pectoralis major myofascial flap. Journal of Otolaryngology 18: 3235.Google ScholarPubMed
Moore, O. S., Karlan, M., Sigler, L. (1969) Factors influencing the safety of carotid ligation. American Journal of Surgery 118: 666668.CrossRefGoogle ScholarPubMed
Moss, W. T., Brand, W. N., Battifora, H. (1979) Radiation Oncology. Rationale, Technique, Results. 5th Edition. C. V. Mosby Co., St Louis. pp 250252.Google Scholar
Price, J. C., Davis, R. K., Koltai, P. J. (1985) The pectoralis major myocutaneous flap for salvage of necrotic wounds. Laryngoscope 95: 146150.CrossRefGoogle ScholarPubMed
Reed, G. F., Halsey, W. 5. (1975) Protection of the carotid artery in radical neck dissection. Laryngoscope 85: 13531358.CrossRefGoogle ScholarPubMed
Rubin, P., Cassarett, G. W. (1968) Clinical Radiation Pathology. Vol 1, W. B. Saunders Co., Philadelphia, pp 471517.Google Scholar
Shindo, M. L., Costantino, P. D., Friedman, C. D., Peizer, H. J., Sisson, G. A., Bressler, F. J. (1992) The pectoralis major myofascial flap for intraoral and pharyngeal reconstruction. Archives of Otolaryngology—Head and Neck Surgery 118: 707711.CrossRefGoogle ScholarPubMed
Shumrick, D. A. (1973) Carotid artery rupture. Laryngoscope 83: 10511061.CrossRefGoogle ScholarPubMed
Staley, C. J. (1961) A muscle cover for the carotid artery after radical neck dissection. American Journal of Surgery 102: 815817.CrossRefGoogle ScholarPubMed