You are now watching: Soft tissue sarcoma of the neck: microsurgical reconstruction

Patient with a recurrent soft tissue sarcoma of the right neck. The common carotid artery is infiltrated by the tumor and has been occluded 3 weeks prior to surgery, after carefully neurological monitoring.
Previous treatment included wide excision, radiotherapy and reconstruction with local flaps.
The surgical plan includes, temporary tracheostomy, radical excision, including carotid artery, and reconstruction of the deffect with a free latissiumus dorsi musculocutaneous flap. Recipient vessels are prepared through an small incision in the contralateral neck. The external jugular vein is located and dissected. The superior thyroid artery is dissected through the same incision. The diameter of the artery, in this patient is smaller than expected. Incongruency between this vessel, and the thoracodorsal/subescapular system is expected, thereby, a second recipient vessel is prepared. The acromiothoracic vessels are exposed through an incision adjacent to the defect. It is advisable to avoid, the main branch of this pedicle, just in case a pectoralis major flap is needed as a salvage procedure. The patient is installed in lateral decubitus. An standard musculocutaneous free latissimus dorsi flap is harvested. The flap is lnsetted to the defect, and microsurgical anastomosis is completed.

Author: Jose R. Castello, MD, Plastic Surgery, Cesar Colmenero, MD, Maxillofacial Surgery, Private Practice, Madrid (Spain). Filmed by Jorge Cano, DDS.

Year: 2008

Duration: 15 minutes 19 seconds

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