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Histopathologic damage to vessels in head and neck microsurgery
Jorge L Alberdas1, Takahiko Shibahara, Hiroyasu Noma
1First Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan.
Summary
Most patients undergoing head and neck microsurgery have pre-existing arterial damage, impacting vessel anastomoses. This damage contributes to technical difficulties and potential graft failure in microvascular reconstruction.
Area of Science:
- Vascular Surgery
- Histopathology
- Microsurgery
Background:
- Microvascular reconstruction is crucial for head and neck cancer surgery.
- Assessing the condition of recipient arteries is vital for successful microvascular anastomoses.
- Pre-existing vascular damage can complicate surgical outcomes.
Purpose of the Study:
- To determine the incidence of pre-existing damage in recipient arteries used for microvascular anastomoses.
- To evaluate the histological characteristics of these damaged vessels.
- To correlate vessel damage with microvascular graft outcomes.
Main Methods:
- Histological examination of 100 head and neck recipient arteries from patients undergoing ablative surgery.
- Assessment of risk factors such as hypertension, myocardial disease, and diabetes.
- Utilized histological staining, scanning electron microscopy, and immunofluorescence for detailed analysis.
Main Results:
- 51% of analyzed arteries exhibited histological abnormalities.
- Common findings included significant thickening of the vessel wall and endothelial cell exfoliation.
- Six graft failures were linked to both technical errors and pre-existing vessel lesions.
Conclusions:
- A high prevalence of pre-existing arterial damage exists in patients undergoing head and neck microsurgery.
- This damage can impede microvascular anastomoses and increase the risk of graft failure.
- Pre-existing vessel changes should be considered critical factors in surgical planning and patient selection.