Histopathologic damage to vessels in head and neck microsurgery

This study assessed the incidence of pre-existing damage in recipient arteries excised before the vessels were used for microvascular anastomoses between 1988 and 1999.

Recipient arteries of the head and neck region from 100 patients who had undergone ablative surgery requiring microvascular tissue reconstruction were examined histologically. Past illnesses believed to be risk factors included hypertension, myocardial disease, and diabetes. Blood vessels chosen for microsurgical anastomoses were examined using histological staining, scanning electron microscopy, and immunofluorescence.

Of the patients undergoing microvascular surgery, 51% showed histologic vessel abnormalities. Marked thickening of the blood vessel wall and severe exfoliation of the endothelial cells were observed in most arteries. Thickening of the intima was evaluated using scanning electron microscopy (Friedman's method; Microvasc Res 3:416, 1971). Values higher than twice the ratio of wall thickness-to-lumen diameter were observed in 9 recipient arteries. Six graft failures were correlated with both technical errors and pre-existing vessel lesions.

This study revealed that most patients undergoing microsurgery in the head and neck region had pre-existing damage to vessels that hindered anastomoses. Pre-existing changes in the recipient arteries may cause technical difficulties and must be regarded as additional factors contributing to graft failure.