Histopathologic damage to vessels in head and neck microsurgery.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Alberdas
Jorge L
JL
First Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan.
Shibahara
Takahiko
T
Noma
Hiroyasu
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001158:Arteries / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D002342:Carotid Artery, External / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D000075202:Contraindications; D016371:Cranial Irradiation / Q000009:adverse effects*; D005145:Face / Q000098:blood supply; D005260:Female; D006084:Graft Rejection; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D013961:Thyroid Gland / Q000098:blood supply
D000970:Antineoplastic Agents