Decreasing the risk of implantation of cancer cells intraoperatively

Maneuvers are suggested to decrease the likelihood of disseminating and implanting cancer cells in wounds during head and neck oncologic surgery, and thereby the risk of local-regional recurrence. These include occlusive covering of fresh tracheotomy sites and areas of skin ulceration, excising the primary tumor before performing neck dissection(s) to avoid contamination of uninvolved tissue planes, irrigation of the field with hypotonic solution after removal of the primary tumor, and using clean instruments and apparel when moving between anatomical sites (e.g., donor flaps/grafts, skull base extensions, percutaneous or standard gastrostomies, etc.).