Use of Occipital Vessels in Head and Neck Microvascular Reconstruction: A Comprehensive Preclinical Evaluation.

Objectives: To assess the use of occipital vessels for microvascular anastomosis in head and neck free tissue transfer reconstruction.

Methods: A literature search was undertaken to identify studies utilizing the occipital vessels for microvascular anastomosis in free tissue transfer. Following literature review, 30 anatomic cadaveric dissections on 15 fresh unfixed cadavers were performed to evaluate the occipital artery and identify a reliable vein within reasonable proximity. In addition, vessel caliber pre- and post-dilation was recorded, along with vessel geometry.

Results: The mean (SD) artery diameter was 2.0 (0.4) mm pre-dilation and 2.8 (0.56) mm post-dilation. An accompanying occipital vein was identified in 20% of dissections (n = 6), with a mean (SD) vein diameter of 1.85 (0.85) mm pre-dilation and 3.5 (0.93) mm post-dilation. When an accompanying occipital vein was not present, the external jugular vein was identified as a suitable vessel for venous outflow. This vessel was identified from 1.0 to 5.0 cm from the mastoid tip, with a mean of 3.3 cm.

Conclusions: The occipital artery may be reliably identified using a limited post-auricular incision. An accompanying occipital vein may be present in a minority of cases; however, the external jugular vein may be easily identified by extending this incision. The occipital vessels may be useful in reconstruction of posterior scalp defects or for use in vessel-depleted necks.

Level of evidence: N/a Laryngoscope, 2025.