The Use of Deep Epigastric Composite Vascular Autograft in the Vessel Depleted Neck

Background Reconstructing the vessel‐depleted neck (VDN) is challenging due to prior surgeries and radiation compromising recipient vessels. The deep epigastric composite vascular autograft (DECVA) offers a novel solution by providing both arterial and venous conduits within a single pedicle. Methods From 2021 to 2023, seven patients with prior head and neck reconstructions underwent free flap reconstruction with DECVA. Preoperative imaging identified contralateral recipient vessels, and DECVA was harvested from the deep inferior epigastric artery and vein. Results All cases achieved successful anastomoses, with an average ischemia time of 157.3 min. No postoperative complications such as thrombosis, infection, or seroma were observed. Conclusion DECVA facilitates single‐stage free flap reconstruction in VDN, extending pedicle length while maintaining vascular integrity. This approach offers a viable alternative for complex cases with limited recipient vessels, expanding reconstructive options in microsurgery.