Introduction: Availability of adequate recipient vessels for microsurgical reconstruction of head and neck cancer in recurrent or previously treated settings can be limited. While the external carotid artery or one of its branches are used most commonly as recipient vessels, there is a need for other options when these are unavailable or unsuitable. The transverse cervical vessels (TCVs) have been described as potential recipients in such difficult reconstructive cases. To that end, the purpose of the present study was to: 1) to determine the anatomic reliability, landmarks and characteristics of the TCVs for use as free flap recipients in challenging cases, and 2) review our clinical experience using the TCVs as recipient vessels over a 10 year period at the McGill University Health Center. Methods: The anatomical characteristics of the TCVs were studied in 16 fresh cadaver dissections. The clinical portion of this study involved a review of all free flap head and neck reconstructions using the TCVs as recipients over a ten year period at the McGill University Head and Neck Surgery Clinic. Results: The transverse cervical artery (TCA) was found to be present above the clavicle in the posterior triangle of the neck in 98% of the dissections, with a usable pedicle length between 40-70mm and an average diameter of 2.7mm. Its origin was consistently 1-2cm under the lateral border of the sternocleidomastoid muscle, 3cm from the midline. Suitable size recipient veins were also identified in 85% of the dissections. Clinically, we report fourteen cases where the TCA was used as a recipient. All but one patient had received preoperative radiation therapy. The TCA was found to be virtually free of fibrosis or atherosclerotic disease in all specimens (clinical and cadaveric) that had received radiation treatment, while the corresponding carotid system was significantly affected. There were no flap failures. Conclusion: Our anatomic study confirms that the TCVs are reliably present with adequate size and length to serve as recipients for free flap reconstruction. In addition, pedicle identification is facilitated by the provided landmarks. The position of the TCA in the posterior triangle of the neck also appears to spare it from surgical manipulation and radiation, thus rendering it particularly useful in salvage surgery and recurrences. This conclusion is supported by the results of our clinical study, demonstrating a 100% flap success rate in previously radiated and difficult reconstructive head and neck cancer cases where the TCA was employed as a recipient.
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