INTERNAL JUGULAR-VEIN THROMBOSIS FOLLOWING MODIFIED NECK DISSECTION -IMPLICATIONS FOR HEAD AND NECK FLAP RECONSTRUCTION

Background. The incidence of internal jugular vein thrombosis (IJVT) f ollowing a modified neck dissection remains uncertain. The effect of, or consequences following, IJVT upon pedicled and free flap head and n eck reconstructions remains unexplored. Methods. Twenty-nine preserved internal jugular veins in 24 patients undergoing modified neck dissec tion were available for prospective study. All patients required a ped icled or free flap reconstruction and received a modified, unilateral or bilateral cervical lymphadenectomy. The patency of all jugular vein s was determined preoperatively and postoperatively using a combinatio n of computed tomography (CT) scanning, high-resolution ultrasound, an d color-flow Doppler (CFD). Results. The IJVT rate was 14%. The presen ce of a pedicled myocutaneous flap and left-sided jugular dissections may represent risks to the postoperative patency of the internal jugul ar vein. Preoperative radiotherapy did not appear to impact negatively upon the thrombosis rate. Conclusions. Thrombosis of the internal jug ular vein may result in significant morbidity for the postoperative on cologic patient. An internal jugular-dependent-free-tissue transfer ma y risk venous compromise of the flap, whereas the use of a pedicled fl ap may place the jugular at increased risk for thrombosis. Strategies for deep venous system microvascular recipient recruitment in the head and neck are discussed. Wherever possible, we employ two deep venous systems, the internal jugular, and subclavian (via the external jugula r) for flap drainage. (C) 1998 John Wiley & Sons, Inc.