Reconstruction of the carotid artery in radical neck dissection

No permanent cure of head-and-neck cancer can be expected when the cancer infiltrates into the wall of the carotid artery. When the carotid artery was resected, the resultant hemiplegia poses very difficult postoperative rehabilitation problems, even though the cancer is eradicated. The recent development of vascular surgery has made reconstruction of the carotid artery feasible. In this paper, the authors reported the indications of reconstruction of the carotid artery in radical neck dissections and the surgical procedures. The indication of reconstruction of the carotid artery is determined by using of angiography, CT-scan and echography. Especially, echography is useful for determining the possibility of reconstructing the carotid artery. In the case of the infiltration type, we can start to remove tumor after preparing for the reconstruction of the carotid artery. The principle of surgical procedures consists of by-pass shunt with a vascular graft between the common and internal carotid arteries, excision of the artery with tumor and insertion of a vascular graft with end-to-end anatomoses. Concerning the selection of a vascular graft, an auto-vein graft is preferable to a synthetic graft in consideration of the postoperative patency of the vascular flow. Moreover, in the case of reconstructing the artery, preoperative irradiation has often been applied and a wide removal of the soft tissue is required, so it is recommended that the myocutaneous flap be used to cover the reconstructed area.