Objective
Preparation of recipient vessels is crucial in free flap reconstruction following head and neck cancer. Generally, branches of the external carotid artery are considered the most appropriate recipients, but their availability may be limited in patients with prior free flap reconstruction. In this study, our experience with the use of the transverse cervical artery (TCA) as recipient vessel for sequential free flap reconstruction (SFFR) is reported.
Materials and methods
This study was conducted retrospectively on a cohort of recurrent head and neck cancer patients who had undergone SFFR between January 2019 and August 2021. We identified all the patients who used the TCA as recipient artery and recorded their clinical data and outcomes.
Results
TCA was used in 12 patients. Anterolateral thigh, anteromedial thigh, profunda femoral artery perforator, and fibula free flaps were used for secondary reconstruction. No vein graft was used. The mean caliber and length of the artery were 2.31 mm (1.5-2.5 mm) and 3.87 cm (3-4.5 cm), respectively. The recipient vein was the external jugular vein in 10 cases and the transverse cervical vein in 2 cases. Three patients reported artery occlusion and total flap necrosis. In all these cases, the TCA measured less than 2 mm in caliber.
Conclusion
The TCA represent a viable recipient vessel for free flap reconstruction due to its sufficient caliber and length. In SFFR for recurrent head and neck cancer cases, we recommend having a contingency plan in place if the TCA caliber is inferior to 2mm intraoperatively.

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