Oncologic Validity of Recipient Vessel Preservation in Microvascular Free-Flap Reconstruction

Abstract

Objectives: The use of free-flap reconstruction requires a more limited neck dissection to allow for microvascular anastomosis. This study seeks to determine the oncologic validity of cervical vessel preservation. Materials and Methods: The current study is a prospective review of cervical vessel biopsies from patients undergoing resection of squamous cell carcinoma (SCCA) tumors of the head and neck with free tissue reconstruction. Results: From June 2010 to March 2012, 227 recipient vessel biopsies were performed on 100 patients. Three of these patients had grossly abnormal vessels, with malignancy confirmed by frozen section analysis. One patient had a vessel positive for malignancy that was grossly normal but found to have SCCA on the final pathology. Conclusions: When the recipient vessel appears grossly suspicious, a frozen section biopsy and re-resection should be considered. Recipient vessel trimmings should routinely be sent for permanent pathology since in rare cases, they can be involved by tumor, affecting the margin status, prognosis, and indications for adjuvant therapy.

Liposuction Contouring After Head and Neck Free Flap Reconstruction

“…From what is available, it is only recommended to insure primary tissue transfer (as discussed above). However, all of tumor stage, positive margins, lymphovascular invasions, and the use of vein grafts significantly correlated with worse overall survival and flap complications [44,45], Furthermore, even though all recipient arteries may potentially be in immediacy to the primary tumor or its metastatic counterpart, random recipient vessel selection and biopsy has no impact on treatment or prognosis (local cancer recurrence, regional cancer recurrence, or distant metastases) [46]. It is however, recommended to biopsy grossly abnormal recipient vessel that are apparent at the time of flap transfer to determine the pathological status of recipient vessel trimmings [46].…”

Liposuction Contouring After Head and Neck Free Flap Reconstruction

“…From what is available, it is only recommended to insure primary tissue transfer (as discussed above). However, all of tumor stage, positive margins, lymphovascular invasions, and the use of vein grafts significantly correlated with worse overall survival and flap complications [44,45], Furthermore, even though all recipient arteries may potentially be in immediacy to the primary tumor or its metastatic counterpart, random recipient vessel selection and biopsy has no impact on treatment or prognosis (local cancer recurrence, regional cancer recurrence, or distant metastases) [46]. It is however, recommended to biopsy grossly abnormal recipient vessel that are apparent at the time of flap transfer to determine the pathological status of recipient vessel trimmings [46].…”